Provider Demographics
NPI:1588346175
Name:COMPASSIONATE CARE BEHAVIORAL SUPPORTS LLC
Entity type:Organization
Organization Name:COMPASSIONATE CARE BEHAVIORAL SUPPORTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA, LBA
Authorized Official - Phone:760-265-9510
Mailing Address - Street 1:2108 N ST STE N
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9225 WILSON RANCH RD
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-7305
Practice Address - Country:US
Practice Address - Phone:760-265-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty