Healthcare Provider Details

I. General information

NPI: 1457821316
Provider Name (Legal Business Name): COMMUNITY COUNSELING AND CORRECTIONAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S CLARK ST
BUTTE MT
59701-1500
US

IV. Provider business mailing address

471 E MERCURY ST
BUTTE MT
59701-1906
US

V. Phone/Fax

Practice location:
  • Phone: 406-496-1172
  • Fax:
Mailing address:
  • Phone: 406-782-0417
  • Fax: 406-782-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateNULL

VIII. Authorized Official

Name: HEATHER MCLAUGHLIN
Title or Position: CORPORATE ACCOUNTANT
Credential: CPB
Phone: 406-496-1172