Provider Demographics
NPI:1184437188
Name:MATTIE DEBOE COUNSELING LLC
Entity type:Organization
Organization Name:MATTIE DEBOE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-406-7016
Mailing Address - Street 1:2716 E PARIS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6139
Mailing Address - Country:US
Mailing Address - Phone:616-406-7016
Mailing Address - Fax:616-975-7702
Practice Address - Street 1:2716 E PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6139
Practice Address - Country:US
Practice Address - Phone:616-406-7016
Practice Address - Fax:616-975-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty