=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477244325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASS COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2023
-----------------------------------------------------
Last Update Date | 05/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 1/2 WEST 3RD ST
-----------------------------------------------------
City | RED WING
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-347-2731
-----------------------------------------------------
Fax | 651-301-7821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31780 HILL VALLEY RD
-----------------------------------------------------
City | RED WING
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55066-7608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-347-2731
-----------------------------------------------------
Fax | 651-301-7821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | SABRENA FAYRE PLATH
-----------------------------------------------------
Credential | MSW, LICSW
-----------------------------------------------------
Telephone | 651-347-2731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------