Healthcare Provider Details

I. General information

NPI: 1164235271
Provider Name (Legal Business Name): COMMUNITY COUNSELING CENTER OF ASHLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SISKIYOU BOULEVARD
ASHLAND OR
97520
US

IV. Provider business mailing address

1136 ANDERSON CK RD
TALENT OR
97540
US

V. Phone/Fax

Practice location:
  • Phone: 541-708-5436
  • Fax:
Mailing address:
  • Phone: 541-840-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON E. BOLLES
Title or Position: CLINICAL DIRECTOR
Credential: L.P.C.
Phone: 541-840-5922