Healthcare Provider Details

I. General information

NPI: 1679348940
Provider Name (Legal Business Name): COMPASS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4063 BIRCH ST STE 220
NEWPORT BEACH CA
92660-2241
US

IV. Provider business mailing address

4063 BIRCH ST STE 220
NEWPORT BEACH CA
92660-2241
US

V. Phone/Fax

Practice location:
  • Phone: 949-229-5708
  • Fax:
Mailing address:
  • Phone: 949-229-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA BORELLI DONCKELS
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 203-887-8857