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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1831815646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY A.M. PEARSON MA MED LPC NCC

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

Provider Business Practice Location Address
First Line	:	1768 FM 2673 STE 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	:	OWNER
Name	:	ANTHONY PEARSON
Credential	:
Telephone Number	:	210-632-0358

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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