Provider Demographics
NPI:1760048250
Name:COMPASS MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:COMPASS MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-254-3407
Mailing Address - Street 1:1060 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2265
Mailing Address - Country:US
Mailing Address - Phone:307-254-3407
Mailing Address - Fax:
Practice Address - Street 1:306 AND 1/2 NORTH BENT
Practice Address - Street 2:SUITE A
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-8243
Practice Address - Country:US
Practice Address - Phone:307-254-3407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY132210901Medicaid