Provider Demographics
NPI:1134553985
Name:COMPASS BEHAVIORAL & DEVELOPMENTAL CONSULTANTS LLC
Entity type:Organization
Organization Name:COMPASS BEHAVIORAL & DEVELOPMENTAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNDON
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DELROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:1800-832-9419
Mailing Address - Street 1:2225 BEMISS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4818
Mailing Address - Country:US
Mailing Address - Phone:800-832-9419
Mailing Address - Fax:855-859-1671
Practice Address - Street 1:2935 N ASHLEY ST STE 112
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1788
Practice Address - Country:US
Practice Address - Phone:800-832-9419
Practice Address - Fax:855-859-1671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0051709103K00000X
252Y00000X, 253Z00000X
FL0000083103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty