Healthcare Provider Details

I. General information

NPI: 1790037315
Provider Name (Legal Business Name): COMPASS BEHAVIORAL CENTER OF HOUMA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
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

4701 W PARK AVE
HOUMA LA
70364-4426
US

V. Phone/Fax

Practice location:
  • Phone: 985-223-0161
  • Fax: 985-223-0162
Mailing address:
  • Phone: 985-876-1715
  • Fax: 985-876-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number711
License Number StateLA

VIII. Authorized Official

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