Healthcare Provider Details

I. General information

NPI: 1487289252
Provider Name (Legal Business Name): COMPASS COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 TARA WAY
LAWTON IA
51030-1026
US

IV. Provider business mailing address

PO BOX 7
JEFFERSON SD
57038-0007
US

V. Phone/Fax

Practice location:
  • Phone: 712-490-6464
  • Fax:
Mailing address:
  • Phone: 712-490-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JESSIE CHRISTOPHERSON
Title or Position: PRACTICE MANAGER
Credential: LMHC
Phone: 712-490-6464