Provider Demographics
NPI:1396340626
Name:COMPASS CHRISTIAN COUNSELING MINISTRIES
Entity type:Organization
Organization Name:COMPASS CHRISTIAN COUNSELING MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:817-601-5877
Mailing Address - Street 1:578 N KIMBALL AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1531
Mailing Address - Country:US
Mailing Address - Phone:817-601-5877
Mailing Address - Fax:
Practice Address - Street 1:578 N KIMBALL AVE STE 150
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1531
Practice Address - Country:US
Practice Address - Phone:817-601-5877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health