MEDICARE: CCS TRAINING SERVICES, INC.

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	E-0877	OH

General Provider Information

NPI Number	:	1104084425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCS TRAINING SERVICES, INC.

Provider Business Mailing Address
First Line	:	850 EUCLID AVE
Second Line	:	SUITE 425
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3306
Country	:	US
Telephone Number	:	216-830-0977
Fax Number	:	216-830-1396

Provider Business Practice Location Address
First Line	:	850 EUCLID AVE
Second Line	:	SUITE 425
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3306
Country	:	US
Telephone Number	:	216-830-0977
Fax Number	:	216-830-1396

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. DONNA R COLES
Credential	:	LPCC
Telephone Number	:	216-830-0977

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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