Healthcare Provider Details

I. General information

NPI: 1861913196
Provider Name (Legal Business Name): COMPASS CHILD COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 TECH DR STE 9
BETTENDORF IA
52722-3277
US

IV. Provider business mailing address

2917 27TH AVENUE A
MOLINE IL
61265-6920
US

V. Phone/Fax

Practice location:
  • Phone: 563-676-0718
  • Fax:
Mailing address:
  • Phone: 217-370-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNA CHUMBLEY
Title or Position: OWNER/LISW
Credential: LISW
Phone: 217-370-7711