Provider Demographics
NPI:1881737849
Name:COMPASS MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:COMPASS MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LAZARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-224-7051
Mailing Address - Street 1:4550 E BELL RD
Mailing Address - Street 2:SUITE 147
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9306
Mailing Address - Country:US
Mailing Address - Phone:602-445-1565
Mailing Address - Fax:602-288-6000
Practice Address - Street 1:4550 E BELL RD
Practice Address - Street 2:SUITE 147
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9306
Practice Address - Country:US
Practice Address - Phone:602-445-1565
Practice Address - Fax:602-288-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH 3143261QR0400X, 261QM0850X, 261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ784729Medicaid