Healthcare Provider Details

I. General information

NPI: 1548561566
Provider Name (Legal Business Name): COMMUNITY COUNSELING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68982 WILLOW CREEK DRIVE
HEPPNER OR
97836
US

IV. Provider business mailing address

PO BOX 469
HEPPNER OR
97836
US

V. Phone/Fax

Practice location:
  • Phone: 541-676-5125
  • Fax: 541-676-5186
Mailing address:
  • Phone: 541-676-9161
  • Fax: 541-676-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number300008
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier274310
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

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