Provider Demographics
NPI:1811533318
Name:BLUE PEARL COUNSELING LLC
Entity type:Organization
Organization Name:BLUE PEARL COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT
Authorized Official - Phone:331-223-0330
Mailing Address - Street 1:825 W STATE ST STE 103D
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 W STATE ST STE 103D
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2078
Practice Address - Country:US
Practice Address - Phone:331-223-0330
Practice Address - Fax:630-528-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty