MEDICARE: COMMUNITY CONNECTIONS, LLC OUTPATIENT CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083189401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CONNECTIONS, LLC OUTPATIENT CLINIC

Provider Business Mailing Address
First Line	:	9208 N 83RD PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-1884
Country	:	US
Telephone Number	:	602-509-5248
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 W BELL RD STE 6
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2748
Country	:	US
Telephone Number	:	602-509-5248
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOEL TEMPLE
Credential	:
Telephone Number	:	602-509-5248

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	10/11/2018

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