MEDICARE: COMPASS BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962917062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	14075 KIMBALL HILL RD
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-5301
Country	:	US
Telephone Number	:	814-897-5828
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 W 21ST ST STE 30
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16506-2972
Country	:	US
Telephone Number	:	814-897-5828
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SOLE MEMBER
Name	:	JENNIFER NICOLE LAROCHE
Credential	:
Telephone Number	:	814-897-5828

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	12/11/2017

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