Provider Demographics
NPI:1609650555
Name:COMPASS ROSE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:COMPASS ROSE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRINCIPAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KWAJALIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:205-246-0671
Mailing Address - Street 1:11460 MARION OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-9258
Mailing Address - Country:US
Mailing Address - Phone:662-425-2804
Mailing Address - Fax:
Practice Address - Street 1:11460 MARION OAKS DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-9258
Practice Address - Country:US
Practice Address - Phone:662-425-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty