Provider Demographics
NPI:1568976942
Name:INNER COMPASS COUNSELING LLC
Entity Type:Organization
Organization Name:INNER COMPASS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JEFFERSON
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-710-6530
Mailing Address - Street 1:12836 LOMAS BLVD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6200
Mailing Address - Country:US
Mailing Address - Phone:505-710-6530
Mailing Address - Fax:
Practice Address - Street 1:12836 LOMAS BLVD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6200
Practice Address - Country:US
Practice Address - Phone:505-710-6530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)