MEDICARE: COMPASS ROSE COUNSELING AND WELLNESS, 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	:	1962143974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS ROSE COUNSELING AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	118 AVENUE C
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-1546
Country	:	US
Telephone Number	:	218-878-9352
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 AVENUE C
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-1546
Country	:	US
Telephone Number	:	218-878-9352
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/OWNER
Name	:	MRS. CASEY LEE WYMAN
Credential	:	MS, LPCC
Telephone Number	:	218-341-9632

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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