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General NPI Number Information
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NPI Number | 1174102537
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Entity Type | Individual
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Provider Name | CORDELL PEARSON
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Gender | Male
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 10149 N 92ND ST STE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4557
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Country | US
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Telephone | 480-256-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 2574 W BENTRUP ST
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City | CHANDLER
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State | AZ
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Zip | 85224-1002
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Country | US
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Telephone | 480-256-9799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC17606
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC19817
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License Number State | AZ
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