MEDICARE: COMPASSIONATE 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	106H00000X	Marriage & Family Therapist	35001820A	IN

General Provider Information

NPI Number	:	1699207399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE COMPASS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	7323 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1504
Country	:	US
Telephone Number	:	317-743-4125
Fax Number	:

Provider Business Practice Location Address
First Line	:	7323 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1504
Country	:	US
Telephone Number	:	317-743-4125
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY J KING
Credential	:	LMFT
Telephone Number	:	317-743-4125

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	03/31/2017

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