Provider Demographics
NPI:1558013904
Name:COMPASS COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:COMPASS COUNSELING SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREITENFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:218-348-6657
Mailing Address - Street 1:23053 STATE 287
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-5299
Mailing Address - Country:US
Mailing Address - Phone:218-348-6657
Mailing Address - Fax:
Practice Address - Street 1:324 BROADWAY ST STE 206
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1482
Practice Address - Country:US
Practice Address - Phone:218-348-6657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21519OtherMN BOARD OF SOCIAL WORK LICENSE