Provider Demographics
NPI:1679348940
Name:COMPASS THERAPY LLC
Entity type:Organization
Organization Name:COMPASS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BORELLI
Authorized Official - Last Name:DONCKELS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-887-8857
Mailing Address - Street 1:4063 BIRCH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2241
Mailing Address - Country:US
Mailing Address - Phone:949-229-5708
Mailing Address - Fax:
Practice Address - Street 1:4063 BIRCH ST STE 220
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2241
Practice Address - Country:US
Practice Address - Phone:949-229-5708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty