Provider Demographics
NPI:1912506908
Name:COMPASSIONATE CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, SAC
Authorized Official - Phone:414-839-1821
Mailing Address - Street 1:985 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4749
Mailing Address - Country:US
Mailing Address - Phone:414-839-1821
Mailing Address - Fax:
Practice Address - Street 1:985 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4749
Practice Address - Country:US
Practice Address - Phone:414-839-1821
Practice Address - Fax:414-446-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841623840Medicaid