Provider Demographics
NPI:1962559872
Name:PEARSON, BRIAN SCOTT (PHD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 HOLMDALE WAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2838
Mailing Address - Country:US
Mailing Address - Phone:734-945-1371
Mailing Address - Fax:734-316-2093
Practice Address - Street 1:198 S INDUSTRIAL DR BLDG D
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9175
Practice Address - Country:US
Practice Address - Phone:734-944-3446
Practice Address - Fax:734-316-2093
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005944103TF0000X
MI6401007956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health