Provider Demographics
NPI:1275257404
Name:PBL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PBL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIEN-LARIVAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:862-268-9000
Mailing Address - Street 1:56 CHURCH ST REAR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2407
Mailing Address - Country:US
Mailing Address - Phone:862-591-0211
Mailing Address - Fax:
Practice Address - Street 1:56 CHURCH ST REAR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2407
Practice Address - Country:US
Practice Address - Phone:862-268-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty