Healthcare Provider Details

I. General information

NPI: 1578501771
Provider Name (Legal Business Name): COMMUNITY COUNSELING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MAIN
HEPPNER OR
97836
US

IV. Provider business mailing address

PO BOX 469
HEPPNER OR
97836
US

V. Phone/Fax

Practice location:
  • Phone: 541-676-9161
  • Fax: 541-676-5662
Mailing address:
  • Phone: 541-676-9161
  • Fax: 541-676-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier035712
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier274310
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MRS. KIMBERLY L LINDSAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-676-9161