Doctor Name: | BENJAMIN PEARSON |
NPI Number: | 1710219035 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 533760601-3501 |
Business Practice Address: | 375 Rainbow Ln Midway, UT - 840497001 |
Business Phone Number: | 4356541082 |
Business Fax Number: | 4356541485 |
Mailing Address: | 375 Rainbow Lane, Po Box 1000 MIDWAY |
State: | UT |
Postal Code: | 84049 |
Phone Number: | 4356541082 |
Fax Number: | 4356541485 |
NPI Enumeration Date: | 02/11/2010 |
NPI Last Update Date: | 08/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 533760601-3501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |