Provider Demographics
NPI:1235028408
Name:PURE WAVES COUNSELING LLC
Entity type:Organization
Organization Name:PURE WAVES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MATTHIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-376-8920
Mailing Address - Street 1:W5820 DELTA DR
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-4400
Mailing Address - Country:US
Mailing Address - Phone:920-376-8920
Mailing Address - Fax:
Practice Address - Street 1:1476 KENWOOD DR STE 102
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1134
Practice Address - Country:US
Practice Address - Phone:920-376-8920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty