Provider Demographics
NPI:1295393478
Name:COMPASSIONATE CHRISTIAN THERAPY, LLC
Entity type:Organization
Organization Name:COMPASSIONATE CHRISTIAN THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN VETTE
Authorized Official - Last Name:WACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-557-9799
Mailing Address - Street 1:16175 ROBBINS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9403
Mailing Address - Country:US
Mailing Address - Phone:616-920-1335
Mailing Address - Fax:
Practice Address - Street 1:16175 ROBBINS RD STE 2
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9403
Practice Address - Country:US
Practice Address - Phone:616-920-1335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003902495Medicaid