Provider Demographics
NPI:1053748814
Name:KOMRAUS COMPASSIONATE COUNSELING PLLC
Entity type:Organization
Organization Name:KOMRAUS COMPASSIONATE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:KOMRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC CAADC
Authorized Official - Phone:586-243-6655
Mailing Address - Street 1:368 SCONE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-1734
Mailing Address - Country:US
Mailing Address - Phone:586-243-6655
Mailing Address - Fax:586-737-7057
Practice Address - Street 1:47100 SCHOENHERR RD
Practice Address - Street 2:STE B
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-4716
Practice Address - Country:US
Practice Address - Phone:586-243-6655
Practice Address - Fax:586-737-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty