Provider Demographics
NPI:1720609647
Name:INNER COMPASS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:INNER COMPASS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR/ MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RAVY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIENG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-307-9373
Mailing Address - Street 1:911 S PARSONS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6042
Mailing Address - Country:US
Mailing Address - Phone:407-307-9373
Mailing Address - Fax:
Practice Address - Street 1:911 S PARSONS AVE STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6042
Practice Address - Country:US
Practice Address - Phone:407-307-9373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW15335OtherLICENSED CLINCIAL SOCIAL WORKER