Provider Demographics
NPI:1376213942
Name:COMPASS INSTITUTE FOR LEADERSHIP DEVELOPMENT
Entity Type:Organization
Organization Name:COMPASS INSTITUTE FOR LEADERSHIP DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:VER STEEG
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:515-988-5189
Mailing Address - Street 1:126 LAFAYETTE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3331
Mailing Address - Country:US
Mailing Address - Phone:515-988-5189
Mailing Address - Fax:
Practice Address - Street 1:126 LAFAYETTE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3331
Practice Address - Country:US
Practice Address - Phone:515-988-5189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health