Basic Information
| Provider Information | |||||||||
| NPI: | 1245326545 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 W CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721502016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709172171 | ||||||||
| FaxNumber: | 4799172161 | ||||||||
| Practice Location | |||||||||
| Address1: | 512 W CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721502016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709172171 | ||||||||
| FaxNumber: | 4799172161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 08/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P0702009 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 2007021410 | MO | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.