MEDICARE: KIMBERLY PEARSON LPC

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	101YM0800X	Mental Health Counselor	73002	TX

General Provider Information

NPI Number	:	1548717606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY PEARSON LPC

Provider Business Mailing Address
First Line	:	828 TIMBER DELL LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-2046
Country	:	US
Telephone Number	:	469-744-2693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 EXETER AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-6305
Country	:	US
Telephone Number	:	469-744-2693
Fax Number	:

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

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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