Active NPI
Amanda Kathleen Pearson
- Licensed Psychiatric Technician
- West Covina, CA
National Provider Identifier
1568093706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 41419
- Practice address
- 100 N Barranca St # 130
West Covina, CA 91791-1637 - Phone
- (626) 701-4669
- NPI assigned
- Jan 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 41419 | CA | Primary |
Addresses
Primary practice location
100 N Barranca St # 130
West Covina, CA 91791-1637
Mailing address
3839 Amanda St Apt 228
West Covina, CA 91792-2797
Phone (909) 552-3391
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41419 | CA | MD | Licensed Psychiatric Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736726400000",
"number": "1568093706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3839 AMANDA ST APT 228",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917922797",
"telephone_number": "909-552-3391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N BARRANCA ST # 130",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917911637",
"telephone_number": "626-701-4669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEARSON",
"first_name": "AMANDA",
"middle_name": "KATHLEEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-27",
"last_updated": "2025-01-13",
"certification_date": "2025-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "41419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.