1861913196 NPI number — COMPASS CHILD COUNSELING, LLC

Table of content: (NPI 1861913196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861913196 NPI number — COMPASS CHILD COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASS CHILD COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861913196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2917 27TH AVENUE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-6920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-370-7711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2395 TECH DR STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETTENDORF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52722-3277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-676-0718
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHUMBLEY
Authorized Official First Name:
JENNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/LISW
Authorized Official Telephone Number:
217-370-7711

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)