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General NPI Number Information
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NPI Number | 1912695495
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Entity Type | Individual
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Provider Name | MICHELLE AUTUMN PEARSON BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 4553 GRAND BLVD STE 206
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-5157
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Country | US
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Telephone | 727-534-3234
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Fax |
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Provider Business Mailing Address
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Address Line | 12586 JAYBIRD RD
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City | WEEKI WACHEE
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State | FL
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Zip | 34614-3267
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Country | US
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Telephone | 352-556-7113
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12258592
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License Number State | FL
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