=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235041617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2026
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 MAIN ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39701-4751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-720-4102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 MAIN ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39701-4751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-720-4102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADULT OUTPATIENT THERAPIST
-----------------------------------------------------
Name | JOHN WOODY SISTRUNK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-720-4102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------