=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821865593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASS BEHAVIORAL HEALTH & WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2023
-----------------------------------------------------
Last Update Date | 12/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2217 EDGAR RD
-----------------------------------------------------
City | POINT PLEASANT BEACH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08742-4419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-539-7412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2217 EDGAR RD
-----------------------------------------------------
City | POINT PLEASANT BEACH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08742-4419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-539-7412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / CEO
-----------------------------------------------------
Name | CAITLIN SIMPSON
-----------------------------------------------------
Credential | DSW, LCSW, LCADC
-----------------------------------------------------
Telephone | 732-539-7412
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------