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General NPI Number Information
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NPI Number | 1346724747
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Entity Type | Organization
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Legal Business Name | COMPASS COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 908 S LEE ST STE A
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City | FORT GIBSON
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State | OK
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Zip | 74434-8735
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Country | US
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Telephone | 903-715-2004
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Fax | 918-203-3116
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Provider Business Mailing Address
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Address Line | PO BOX 776
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City | FORT GIBSON
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State | OK
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Zip | 74434-0776
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Country | US
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Telephone | 903-715-2004
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Fax | 918-203-3116
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALEC STORM MORENO
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Credential | LMSW, LCSW
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Telephone | 903-715-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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