MEDICARE: CCA COMPANIES LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1427202647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCA COMPANIES LLC

Provider Business Mailing Address
First Line	:	810 ORCHARD LN STE 102
Second Line	:
City	:	BEAVERCREEK TOWNSHIP
State	:	OH
Zip	:	45434-7221
Country	:	US
Telephone Number	:	937-431-3870
Fax Number	:	937-431-3871

Provider Business Practice Location Address
First Line	:	810 ORCHARD LN STE 102
Second Line	:
City	:	BEAVERCREEK TOWNSHIP
State	:	OH
Zip	:	45434-7221
Country	:	US
Telephone Number	:	937-431-3870
Fax Number	:	937-431-3871

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. LEANNA E MANUEL
Credential	:	PSY.D.
Telephone Number	:	937-431-3870

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	05/03/2012

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