Provider Demographics
NPI:1700998770
Name:PEARSON, CHERYLL ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERYLL
Middle Name:ANNE
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 1:836 E EUCLID AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1783
Mailing Address - Country:US
Mailing Address - Phone:859-268-7386
Mailing Address - Fax:502-863-5367
Practice Address - Street 1:836 E EUCLID AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1783
Practice Address - Country:US
Practice Address - Phone:859-268-7386
Practice Address - Fax:502-863-5367
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0817103T00000X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000323831Medicare UPIN