Provider Demographics
NPI:1437673027
Name:COURAGE COMPASS THERAPY
Entity Type:Organization
Organization Name:COURAGE COMPASS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SURNITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:215-500-7470
Mailing Address - Street 1:5200 IVYSTREAM RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3012
Mailing Address - Country:US
Mailing Address - Phone:215-500-7470
Mailing Address - Fax:844-520-6984
Practice Address - Street 1:208 EASTON RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3205
Practice Address - Country:US
Practice Address - Phone:267-209-0795
Practice Address - Fax:844-520-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty