Healthcare Provider Details

I. General information

NPI: 1669448544
Provider Name (Legal Business Name): COMMUNITY COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2458 STETZER RD
BUCYRUS OH
44820-2066
US

IV. Provider business mailing address

2458 STETZER RD PO BOX 765
BUCYRUS OH
44820-2066
US

V. Phone/Fax

Practice location:
  • Phone: 419-562-2000
  • Fax:
Mailing address:
  • Phone: 419-562-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1057
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0177
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0177
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0177
License Number StateOH

VIII. Authorized Official

Name: MR. PAUL E SIPES
Title or Position: CONTROLLER
Credential: CPA
Phone: 419-562-2000