MEDICARE: COMPASS ROSE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1962041350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS ROSE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	44 E SPAULDING AVE STE 1
Second Line	:
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	719-582-3003
Fax Number	:	866-286-8545

Provider Business Practice Location Address
First Line	:	44 E SPAULDING AVE STE 1
Second Line	:
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	719-582-3003
Fax Number	:	866-286-8545

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	SARAH R FOWLER
Credential	:	LPC
Telephone Number	:	719-582-3003

Provider Enumeration Date	:	01/02/2020
Last Update Date	:	09/20/2021

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