Provider Demographics
NPI:1144340886
Name:PEARSON, TERRY ANDREW (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ANDREW
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1111
Mailing Address - Country:US
Mailing Address - Phone:502-473-7376
Mailing Address - Fax:502-473-7376
Practice Address - Street 1:2100 GARDINER LN
Practice Address - Street 2:SUITE 307
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2962
Practice Address - Country:US
Practice Address - Phone:502-456-1990
Practice Address - Fax:502-473-7376
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0931103TC0700X
IN20041619A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCP00151Medicare ID - Type Unspecified
KYS00694Medicare UPIN