Provider Demographics
NPI:1063956852
Name:COMPASS BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:COMPASS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-516-8852
Mailing Address - Street 1:88 RIDGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1937
Mailing Address - Country:US
Mailing Address - Phone:203-516-8852
Mailing Address - Fax:
Practice Address - Street 1:43 SHERMAN HILL RD
Practice Address - Street 2:BUILDING D, SUITE 104
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3651
Practice Address - Country:US
Practice Address - Phone:203-516-8852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty