MEDICARE: INNER 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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568976942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER COMPASS COUNSELING LLC

Provider Business Mailing Address
First Line	:	12836 LOMAS BLVD NE STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-6200
Country	:	US
Telephone Number	:	505-710-6530
Fax Number	:

Provider Business Practice Location Address
First Line	:	12836 LOMAS BLVD NE STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-6200
Country	:	US
Telephone Number	:	505-710-6530
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DAVID JEFFERSON BOSTON
Credential	:	LPCC
Telephone Number	:	505-710-6530

Provider Enumeration Date	:	11/22/2017
Last Update Date	:	01/10/2025

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Directions to “INNER COMPASS COUNSELING LLC ” Practice Location

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