Provider Demographics
NPI:1659487510
Name:PEARSON, STACEY M (PHD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E WILLIAM ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2446
Mailing Address - Country:US
Mailing Address - Phone:734-657-2803
Mailing Address - Fax:
Practice Address - Street 1:514 E WILLIAM ST STE A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2446
Practice Address - Country:US
Practice Address - Phone:734-657-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist