Provider Demographics
NPI:1144932351
Name:COMPASSION NEUROSCIENCE
Entity type:Organization
Organization Name:COMPASSION NEUROSCIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:TENNYSON
Authorized Official - Last Name:TOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-888-6974
Mailing Address - Street 1:771 E SOUTHLAKE BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7065
Mailing Address - Country:US
Mailing Address - Phone:817-888-6974
Mailing Address - Fax:
Practice Address - Street 1:771 E SOUTHLAKE BLVD STE 222
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7065
Practice Address - Country:US
Practice Address - Phone:817-888-6974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)