| Compass Counseling Services Pllc | |
|
908 S Lee St Ste A Fort Gibson OK 74434-8735 | |
| (903) 715-2004 | |
| (918) 203-3116 |
| Full Name | Compass Counseling Services Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 908 S Lee St Ste A, Fort Gibson, Oklahoma |
| Authorized Official Name and Position | Alec Storm Moreno (OWNER) |
| Authorized Official Contact | 9037152004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Compass Counseling Services Pllc Po Box 776 Fort Gibson OK 74434-0776 Ph: (903) 715-2004 | Compass Counseling Services Pllc 908 S Lee St Ste A Fort Gibson OK 74434-8735 Ph: (903) 715-2004 |
| NPI Number | 1346724747 |
|---|---|
| Provider Enumeration Date | 09/20/2018 |
| Last Update Date | 12/28/2022 |
| Certification Date | 12/28/2022 |
| Medicare PECOS PAC ID | 2264764794 |
|---|---|
| Medicare Enrollment ID | O20191101000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346724747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alec Storm Moreno |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568884666 PECOS PAC ID: 6507121894 Enrollment ID: I20191101000409 |
| Provider Name | Elizabeth Ruth Wulf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245651538 PECOS PAC ID: 9234563024 Enrollment ID: I20200103000533 |
| Provider Name | Ethan Randall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508526773 PECOS PAC ID: 5496148314 Enrollment ID: I20220216002502 |
| Provider Name | Tamara Gaskin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972049765 PECOS PAC ID: 4587017108 Enrollment ID: I20240131001403 |
| Provider Name | Katherine Elizabeth Moreno |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528428810 PECOS PAC ID: 6709226970 Enrollment ID: I20240506000179 |
Green Country Behavioral Health Services, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 Ross Ave, Fort Gibson, OK 74434 Phone: 918-682-8407 |