1578501771 NPI number — COMMUNITY COUNSELING SOLUTIONS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578501771 NPI number — COMMUNITY COUNSELING SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY COUNSELING SOLUTIONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FORMERLY MORROW COUNTY BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578501771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 469
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEPPNER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-676-9161
Provider Business Mailing Address Fax Number:
541-676-5662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEPPNER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-676-9161
Provider Business Practice Location Address Fax Number:
541-676-5662
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LINDSAY
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
541-676-9161

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 035712 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 274310 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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