Basic Information
| Provider Information | |||||||||
| NPI: | 1841468667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERSON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MA, MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8524 ALOPHIA DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787392105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8572251212 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2410 E RIVERSIDE DR STE G3 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787413053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124724357 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2008 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 1041C0700X | 54759 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.