Healthcare Provider Details

I. General information

NPI: 1598263469
Provider Name (Legal Business Name): COMPASS COUNSELING AND CONSULTING SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14074 TRADE CENTER DR STE 247
FISHERS IN
46038-4579
US

IV. Provider business mailing address

14074 TRADE CENTER DR STE 247
FISHERS IN
46038-4579
US

V. Phone/Fax

Practice location:
  • Phone: 317-459-0676
  • Fax:
Mailing address:
  • Phone: 317-459-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number34006593A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number34006593A
License Number StateIN

VIII. Authorized Official

Name: MS. BRISHEN MARIE LEWIS-WEIR
Title or Position: BEHAVIORAL HEALTH THERAPIST
Credential: MS
Phone: 317-459-0676