MEDICARE: COMPASSIONATE COUNSELING AND CONSULTING SERVICES, 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1932860061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE COUNSELING AND CONSULTING SERVICES, LLC

Provider Business Mailing Address
First Line	:	7028 CHATHAM DR
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-2414
Country	:	US
Telephone Number	:	205-821-6754
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 CENTER POINT PKWY STE 202
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35215-5666
Country	:	US
Telephone Number	:	205-821-6754
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER/THERAPIST
Name	:	TYSHELLE WILSON
Credential	:	LICSW
Telephone Number	:	205-821-6754

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	12/30/2021

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