Healthcare Provider Details

I. General information

NPI: 1154648301
Provider Name (Legal Business Name): COMPASS PSYCHIATRIC SPECIALTIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6472 W MAIN ST
HOUMA LA
70360-2265
US

IV. Provider business mailing address

PO BOX 428
CROWLEY LA
70527-0428
US

V. Phone/Fax

Practice location:
  • Phone: 337-442-3163
  • Fax: 318-442-4779
Mailing address:
  • Phone: 337-785-8003
  • Fax: 337-785-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP05139
License Number StateLA

VIII. Authorized Official

Name: MARK CULLEN
Title or Position: CEO
Credential:
Phone: 337-788-3330