Healthcare Provider Details

I. General information

NPI: 1205213758
Provider Name (Legal Business Name): COMPASS COUNSELORS LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 IAA DRIVE
BLOOMINGTON IL
61701-2225
US

IV. Provider business mailing address

6073 E 1100 NORTH RD
BLOOMINGTON IL
61705-6731
US

V. Phone/Fax

Practice location:
  • Phone: 309-261-6129
  • Fax: 309-808-0617
Mailing address:
  • Phone: 309-261-6129
  • Fax: 309-261-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.009588
License Number StateIL

VIII. Authorized Official

Name: JOHN LESLIE FRESHOUR
Title or Position: PRESIDENT
Credential:
Phone: 309-261-6129