Provider Demographics
NPI:1093802795
Name:COMPREHENSIVE MENTAL HEALTH CENTER OF ALEXANDRIA, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE MENTAL HEALTH CENTER OF ALEXANDRIA, LLC
Other - Org Name:COMPASS PSYCHIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-785-8003
Mailing Address - Street 1:426 N AVENUE G
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-4438
Mailing Address - Country:US
Mailing Address - Phone:337-785-8003
Mailing Address - Fax:337-785-8045
Practice Address - Street 1:4606 LEE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3235
Practice Address - Country:US
Practice Address - Phone:318-442-3163
Practice Address - Fax:318-442-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60104OtherBCBS
LA194623Medicare ID - Type UnspecifiedMENTAL HEALTH