Provider Demographics
NPI:1518706316
Name:PIERSON, LORI LOUISE
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:LOUISE
Last Name:PIERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 COOLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2231
Mailing Address - Country:US
Mailing Address - Phone:909-231-1850
Mailing Address - Fax:
Practice Address - Street 1:1565 COOLCREST AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2231
Practice Address - Country:US
Practice Address - Phone:909-231-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110672106H00000X
CA268530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty