Provider Demographics
NPI:1003319641
Name:BD COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:BD COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:DEMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:717-682-8215
Mailing Address - Street 1:28 S POPLAR ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2158
Mailing Address - Country:US
Mailing Address - Phone:717-682-8215
Mailing Address - Fax:888-977-1063
Practice Address - Street 1:28 S POPLAR ST STE 102
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2158
Practice Address - Country:US
Practice Address - Phone:717-682-8215
Practice Address - Fax:888-977-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC008154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty