Provider Demographics
NPI:1902253511
Name:SUTTER COMPASS THERAPY, LLC
Entity Type:Organization
Organization Name:SUTTER COMPASS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST, SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISW-S, MSW
Authorized Official - Phone:740-591-1741
Mailing Address - Street 1:2350 CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3045
Mailing Address - Country:US
Mailing Address - Phone:478-238-0462
Mailing Address - Fax:478-257-8247
Practice Address - Street 1:2350 CLAYTON ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3045
Practice Address - Country:US
Practice Address - Phone:478-238-0462
Practice Address - Fax:478-257-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0057901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty