Healthcare Provider Details

I. General information

NPI: 1093240210
Provider Name (Legal Business Name): COMPASS COUNSELING AND PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 HACKENSACK AVE STE 200
HACKENSACK NJ
07601-6331
US

IV. Provider business mailing address

411 HACKENSACK AVE STE 200
HACKENSACK NJ
07601-6331
US

V. Phone/Fax

Practice location:
  • Phone: 973-519-6961
  • Fax:
Mailing address:
  • Phone: 973-519-2826
  • Fax: 973-532-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number37PC00503200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37PC00503200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MICHAEL WILSON
Title or Position: OWNER
Credential:
Phone: 973-519-2826