Provider Demographics
NPI:1992056246
Name:PEARSON, AMBER W (MA, LPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:W
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0155
Mailing Address - Country:US
Mailing Address - Phone:720-644-6378
Mailing Address - Fax:
Practice Address - Street 1:11001 W 120TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3493
Practice Address - Country:US
Practice Address - Phone:720-644-6378
Practice Address - Fax:720-446-3520
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-6479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40876870Medicaid