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General NPI Number Information
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NPI Number | 1831767888
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Entity Type | Individual
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Provider Name | MAE PEARL TA AMFT, APCC
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 1835 PARK AVE
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City | SAN JOSE
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State | CA
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Zip | 95126-1629
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Country | US
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Telephone | 303-989-8169
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Fax |
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Provider Business Mailing Address
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Address Line | 333 SUNOL ST UNIT 336
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City | SAN JOSE
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State | CA
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Zip | 95126-4380
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Country | US
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Telephone | 669-226-2100
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8808
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 122719
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License Number State | CA
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