Provider Demographics
NPI:1518658319
Name:COMPASS THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:COMPASS THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOWALCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-585-6522
Mailing Address - Street 1:937 PAOLI PIKE # 1019
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1724 BARKER CIR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6188
Practice Address - Country:US
Practice Address - Phone:610-585-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health