Provider Demographics
NPI:1366861643
Name:COMPASS BEHAVIORAL HEALTH, A FAMILY THERAPY CORP
Entity Type:Organization
Organization Name:COMPASS BEHAVIORAL HEALTH, A FAMILY THERAPY CORP
Other - Org Name:COMPASS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:888-265-9114
Mailing Address - Street 1:130 S B ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3609
Mailing Address - Country:US
Mailing Address - Phone:888-265-9114
Mailing Address - Fax:714-486-1629
Practice Address - Street 1:130 S B ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3609
Practice Address - Country:US
Practice Address - Phone:888-265-9114
Practice Address - Fax:714-486-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA193200000XOtherMULTI-SPECIALTY GROUP