Basic Information
| Provider Information | |||||||||
| NPI: | 1780854836 | ||||||||
| 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 | ||||||||
| FaxNumber: | 4195621296 | ||||||||
| Practice Location | |||||||||
| Address1: | 2458 STETZER RD | ||||||||
| Address2: | |||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448202066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195622000 | ||||||||
| FaxNumber: | 4195621296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 03/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | SIPES | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4195622000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY COUNSELING SERVICES INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 0177 | OH | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 9220681 | 01 | OH | MEDICARE | OTHER | 0177 | 01 | OH | ODMH CERTIFICATION | OTHER | 1057 | 01 | OH | ODMH MACSIS | OTHER | 2480748 | 05 | OH | MEDICAID |