MEDICARE: COMPASS COUNSELING GROUP, PLLC

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

General Provider Information

NPI Number	:	1871868141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS COUNSELING GROUP, PLLC

Provider Business Mailing Address
First Line	:	501 N MUSTANG RD STE G
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-7044
Country	:	US
Telephone Number	:	405-376-3600
Fax Number	:	405-376-3606

Provider Business Practice Location Address
First Line	:	501 N MUSTANG RD STE G
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-7044
Country	:	US
Telephone Number	:	405-376-3600
Fax Number	:	405-376-3606

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MS. LINDA MARIE COMPTON
Credential	:	LPC, LADC, NCC, CM
Telephone Number	:	405-445-8687

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/22/2012

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