=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568628097
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM L PEARSON M.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2008
-----------------------------------------------------
Last Update Date | 08/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26077 SCHAFER DR
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-7300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-625-1192
-----------------------------------------------------
Fax | 310-315-4951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26077 SCHAFER DR
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-7300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-625-1192
-----------------------------------------------------
Fax | 310-315-4951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT 31135
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------