Healthcare Provider Details

I. General information

NPI: 1477416923
Provider Name (Legal Business Name): COMMUNITY COUNSELING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SE 2ND STREET
PENDLETON OR
97801
US

IV. Provider business mailing address

331 SE 2ND STREET
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-310-1971
  • Fax:
Mailing address:
  • Phone: 541-310-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATIE ANN CLARK
Title or Position: MENTAL HEALTH SPECIALIST 1 / QMHA-R
Credential:
Phone: 541-310-1971