Provider Demographics
NPI:1740734755
Name:COMPASSIONATE COUNSELING PSYCHOTHERAPY SERVICE LLC
Entity Type:Organization
Organization Name:COMPASSIONATE COUNSELING PSYCHOTHERAPY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:R MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-688-9221
Mailing Address - Street 1:4607 JAMAICA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2839
Mailing Address - Country:US
Mailing Address - Phone:505-688-9221
Mailing Address - Fax:
Practice Address - Street 1:5800 MCLEOD RD NE
Practice Address - Street 2:SUITE E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2454
Practice Address - Country:US
Practice Address - Phone:505-688-9221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2575101YM0800X
NMC-21631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85971511Medicaid
NM000J4878Medicaid