Healthcare Provider Details

I. General information

NPI: 1013388065
Provider Name (Legal Business Name): COMPASS COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 2ND AVE E
REEDER ND
58649-4913
US

IV. Provider business mailing address

PO BOX 247
REEDER ND
58649-0247
US

V. Phone/Fax

Practice location:
  • Phone: 701-853-2795
  • Fax: 701-853-2796
Mailing address:
  • Phone: 701-853-2795
  • Fax: 701-853-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC1174
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number732-9-15-12
License Number StateND

VIII. Authorized Official

Name: JADA MARIA HOFLAND
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: MS-LPCC
Phone: 701-853-2795