Healthcare Provider Details

I. General information

NPI: 1851045686
Provider Name (Legal Business Name): COMPASS BEHAVIORAL HEALTH, A FAMILY THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S B ST
TUSTIN CA
92780-3609
US

IV. Provider business mailing address

12103 REDHILL AVE
SANTA ANA CA
92705-3109
US

V. Phone/Fax

Practice location:
  • Phone: 888-265-9114
  • Fax: 714-486-1629
Mailing address:
  • Phone: 888-265-9114
  • Fax: 714-486-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHERIE MILLS
Title or Position: EXECUTIVE DIRECTOR / OWNER
Credential: LMFT
Phone: 888-265-9114