Basic Information
| Provider Information | |||||||||
| NPI: | 1669448544 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY COUNSELING SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2458 STETZER RD | ||||||||
| Address2: | PO BOX 765 | ||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448202066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195622000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2458 STETZER RD | ||||||||
| Address2: | |||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448202066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195622000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | SIPES | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4195622000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 0177 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | 0177 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 0177 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261Q00000X | 1057 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 2444653 | 05 | OH | MEDICAID | 1057 | 01 | OH | ODADAS CERTIFICATE NUMBER | OTHER | 0177 | 01 | OH | ODMH CERTIFICATE NUMBER | OTHER |