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General NPI Number Information
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NPI Number | 1215378625
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Entity Type | Individual
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Provider Name | CHRISTIAN LUCAS PEARSON L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2013
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Last Update Date | 07/13/2013
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Provider Practice Location Address
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Address Line | 1325 HEPBURN AVE APT 1
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City | LOUISVILLE
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State | KY
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Zip | 40204-1613
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Country | US
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Telephone | 812-701-0821
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 HEPBURN AVE APT 1
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City | LOUISVILLE
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State | KY
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Zip | 40204-1613
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Country | US
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Telephone | 812-701-0821
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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 | 364SH1100X
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Taxonomy Name | Holistic Clinical Nurse Specialist
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License Number | KY-4659
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License Number State | KY
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