Basic Information
| Provider Information | |||||||||
| NPI: | 1053378562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 E DOUGLAS AVE | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982296817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607382330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3645 E MCLEOD RD | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606762220 | ||||||||
| FaxNumber: | 3606767750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH00006446 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 6961PE | 01 | WA | REGENCE BLUE SHIELD | OTHER |