=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770039117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELICA PEARCE TLMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2016
-----------------------------------------------------
Last Update Date | 08/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 GOLDFINCH RD
-----------------------------------------------------
City | HORTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66439-9537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-486-2154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1117 GOLDFINCH RD
-----------------------------------------------------
City | HORTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66439-9537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-486-2154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 2787
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------