Healthcare Provider Details

I. General information

NPI: 1942975958
Provider Name (Legal Business Name): COMMUNITY COUNSELING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SW 1ST ST
PENDLETON OR
97801-2139
US

IV. Provider business mailing address

PO BOX 469
HEPPNER OR
97836-0469
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-6330
  • Fax:
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 State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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