Provider Demographics
NPI:1629717723
Name:PEARL, BURLISA S (LPC, DOULA&PPNE)
Entity Type:Individual
Prefix:
First Name:BURLISA
Middle Name:S
Last Name:PEARL
Suffix:
Gender:F
Credentials:LPC, DOULA&PPNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:HANNA CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61536-9742
Mailing Address - Country:US
Mailing Address - Phone:309-989-7082
Mailing Address - Fax:
Practice Address - Street 1:310 S MURPHY RD
Practice Address - Street 2:
Practice Address - City:HANNA CITY
Practice Address - State:IL
Practice Address - Zip Code:61536-9742
Practice Address - Country:US
Practice Address - Phone:309-265-7028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017555101YM0800X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health