Provider Demographics
NPI:1679802565
Name:PEARSON, DAVID HYRUM (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HYRUM
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 E. STATE AVE.
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2342
Mailing Address - Country:US
Mailing Address - Phone:208-914-4903
Mailing Address - Fax:
Practice Address - Street 1:39 E. STATE AVE.
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2342
Practice Address - Country:US
Practice Address - Phone:208-914-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist