Provider Demographics
NPI:1861950933
Name:COMPASSIONATE CHRIST CENTERED COUNSELING, LLC
Entity type:Organization
Organization Name:COMPASSIONATE CHRIST CENTERED COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:313-775-9802
Mailing Address - Street 1:7289 EDWARD
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1008
Mailing Address - Country:US
Mailing Address - Phone:313-775-9802
Mailing Address - Fax:
Practice Address - Street 1:2888 E LONG LAKE RD STE 170
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-7011
Practice Address - Country:US
Practice Address - Phone:248-864-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health