Provider Demographics
NPI:1104428960
Name:COMPASS CROSSING MENTAL HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:COMPASS CROSSING MENTAL HEALTH AND WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACRESHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROX
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:216-372-0349
Mailing Address - Street 1:5001 MAYFIELD RD STE 112
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2608
Mailing Address - Country:US
Mailing Address - Phone:216-454-2570
Mailing Address - Fax:
Practice Address - Street 1:5001 MAYFIELD RD STE 112
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2608
Practice Address - Country:US
Practice Address - Phone:216-454-2570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)