MEDICARE: ANTHONY A.M. PEARSON MA, MED, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor		TX
2	106H00000X	Marriage & Family Therapist	201487	TX
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1295089308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY A.M. PEARSON MA, MED, LPC, NCC

Provider Business Mailing Address
First Line	:	1768 FM 2673 UNIT 2
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4768
Country	:	US
Telephone Number	:	121-063-2035
Fax Number	:

Provider Business Practice Location Address
First Line	:	1768 FM 2673 UNIT 2
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4768
Country	:	US
Telephone Number	:	210-632-0358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	04/21/2022

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