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General NPI Number Information
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NPI Number | 1497049399
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Entity Type | Organization
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Legal Business Name | JENNIFER PEARSON LMFT
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 6607 18TH AVE S
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City | RICHFIELD
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State | MN
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Zip | 55423-2784
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Country | US
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Telephone | 612-798-7373
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Fax |
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Provider Business Mailing Address
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Address Line | 6607 18TH AVE S
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City | RICHFIELD
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State | MN
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Zip | 55423-2784
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Country | US
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Telephone | 612-798-7373
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MS. JENNIFER SECREST PEARSON
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Credential | M.ED, LMFT
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Telephone | 612-798-7373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 964
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License Number State | MN
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