MEDICARE: COMPASS COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	373	WY

General Provider Information

NPI Number	:	1477049567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS COUNSELING LLC

Provider Business Mailing Address
First Line	:	PO BOX 20168
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82003-7004
Country	:	US
Telephone Number	:	307-638-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 CENTRAL AVE STE 154
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4531
Country	:	US
Telephone Number	:	307-509-9237
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALAN NESS
Credential	:	LAT
Telephone Number	:	307-509-9237

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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