Provider Demographics
NPI:1902164619
Name:COMPASS BEHAVIORAL CENTER LLC
Entity Type:Organization
Organization Name:COMPASS BEHAVIORAL CENTER LLC
Other - Org Name:COMPASS BEHAVIORAL CENTER OF LAFAYETTE
Other - Org Type:Doing Business As
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 1:312 YOUNGSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4524
Mailing Address - Country:US
Mailing Address - Phone:337-534-4655
Mailing Address - Fax:
Practice Address - Street 1:312 YOUNGSVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-534-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASS BEHAVIORAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
LA283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1704351Medicaid
19408500Medicare Oscar/Certification