Provider Demographics
NPI:1609150804
Name:FAMILY COMPASS
Entity Type:Organization
Organization Name:FAMILY COMPASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER AND CO-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-401-0676
Mailing Address - Street 1:PO BOX 500006
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-0006
Mailing Address - Country:US
Mailing Address - Phone:512-401-0676
Mailing Address - Fax:512-401-0676
Practice Address - Street 1:10617 GLASS MOUNTAIN TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2502
Practice Address - Country:US
Practice Address - Phone:512-401-0676
Practice Address - Fax:512-401-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1568248 03171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty