Provider Demographics
NPI:1790037315
Name:COMPASS BEHAVIORAL CENTER OF HOUMA, INC.
Entity Type:Organization
Organization Name:COMPASS BEHAVIORAL CENTER OF HOUMA, INC.
Other - Org Name:COMPASS PSYCHIATRIC SPECIALTIES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-788-3330
Mailing Address - Street 1:4701 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-4426
Mailing Address - Country:US
Mailing Address - Phone:985-876-1715
Mailing Address - Fax:985-876-1750
Practice Address - Street 1:6472 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2265
Practice Address - Country:US
Practice Address - Phone:985-223-0161
Practice Address - Fax:985-223-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA711283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital