Provider Demographics
NPI: | 1306448279 |
---|---|
Name: | COMPASSIONATE CARE LSC, INCORPORATION |
Entity type: | Organization |
Organization Name: | COMPASSIONATE CARE LSC, INCORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/THERAPIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | SCOTT CRUSING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MA, LCPC, CADC, MISA |
Authorized Official - Phone: | 815-464-8210 |
Mailing Address - Street 1: | 20646 ABBEY WOODS CT N STE 205 |
Mailing Address - Street 2: | |
Mailing Address - City: | FRANKFORT |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60423-3177 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 815-464-8210 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 20646 ABBEY WOODS CT N STE 205 |
Practice Address - Street 2: | |
Practice Address - City: | FRANKFORT |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60423-3177 |
Practice Address - Country: | US |
Practice Address - Phone: | 815-464-8210 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-11-14 |
Last Update Date: | 2020-11-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty |