Basic Information
| Provider Information | |||||||||
| NPI: | 1780129791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY FIRST THERAPY AND CONSULTING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2432 | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012022432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136790333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 S CHURCH ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012016128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136790333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2016 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCKENZIE | ||||||||
| AuthorizedOfficialFirstName: | CHARELL | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2404598210 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW-C | ||||||||
| NPICertificationDate: | 01/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 18545 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 333728600 | 05 | MD | MEDICAID |