Provider Demographics
NPI:1750788758
Name:LIFE COMPASS COUNSELING LLC
Entity type:Organization
Organization Name:LIFE COMPASS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VANHOVE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-431-9050
Mailing Address - Street 1:831 ROYAL GORGE BLVD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-6709
Mailing Address - Country:US
Mailing Address - Phone:719-431-9050
Mailing Address - Fax:
Practice Address - Street 1:831 ROYAL GORGE BLVD
Practice Address - Street 2:SUITE 226
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-6709
Practice Address - Country:US
Practice Address - Phone:719-431-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099235021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12774090OtherCAQH
CO16976223Medicaid