Provider Demographics
NPI:1548347743
Name:COMPTON
Entity type:Organization
Organization Name:COMPTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MH COUNSELOR RN
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-668-6891
Mailing Address - Street 1:803 E VICTORIA ST
Mailing Address - Street 2:UNIT 132
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1565
Mailing Address - Country:US
Mailing Address - Phone:310-354-2939
Mailing Address - Fax:
Practice Address - Street 1:921 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3303
Practice Address - Country:US
Practice Address - Phone:310-668-6891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250177163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty