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General NPI Number Information
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NPI Number | 1811533318
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Entity Type | Organization
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Legal Business Name | BLUE PEARL COUNSELING LLC
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 825 W STATE ST STE 103D
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City | GENEVA
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State | IL
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Zip | 60134-2078
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Country | US
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Telephone | 331-223-0330
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Fax | 630-528-0775
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Provider Business Mailing Address
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Address Line | 825 W STATE ST STE 103D
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City | GENEVA
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State | IL
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Zip | 60134-2078
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER, ADMINISTRATOR
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Name | MARYANN DEMATTHEWS
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Credential | MS LMFT
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Telephone | 331-223-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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