Provider Demographics
NPI:1649737990
Name:COMPASS CLINIC
Entity Type:Organization
Organization Name:COMPASS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUTHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-445-0869
Mailing Address - Street 1:701 NE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7203
Mailing Address - Country:US
Mailing Address - Phone:405-445-0869
Mailing Address - Fax:
Practice Address - Street 1:701 NE 36TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7203
Practice Address - Country:US
Practice Address - Phone:405-445-0869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder