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General NPI Number Information
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NPI Number | 1750639654
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Entity Type | Individual
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Provider Name | BRYANT PEARSON MSW, CSW
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Gender | Male
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 400 EAST 200 NORTH
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City | PANGUITCH
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State | UT
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Zip | 84759
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Country | US
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Telephone | 435-676-1551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 29
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City | PANGUITCH
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State | UT
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Zip | 84759-0029
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Country | US
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Telephone | 801-589-0485
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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