Provider Demographics
NPI:1215922489
Name:PEARL, RICK STEVEN (LCSW, LPC)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:STEVEN
Last Name:PEARL
Suffix:
Gender:M
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 REINDEER DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5174
Mailing Address - Country:US
Mailing Address - Phone:636-230-6064
Mailing Address - Fax:773-496-1232
Practice Address - Street 1:677 N NEW BALLAS RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6732
Practice Address - Country:US
Practice Address - Phone:636-230-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR01061Medicare UPIN