Healthcare Provider Details

I. General information

NPI: 1053564294
Provider Name (Legal Business Name): JAMES HOLM PEARCE MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 MAIN STREET
EAST MACHIAS ME
04630
US

IV. Provider business mailing address

25 SEA XING
ROQUE BLUFFS ME
04654-3134
US

V. Phone/Fax

Practice location:
  • Phone: 207-263-3255
  • Fax:
Mailing address:
  • Phone: 207-263-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 28644
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF5229
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: