MEDICARE: THE COMMUNITY COUNSELING & HOUSING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	253Z00000X	In Home Supportive Care Agency
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
4	261QR0800X	Recovery Care Clinic/Center
5	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
6	3336M0003X	Managed Care Organization Pharmacy
7	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1508365198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COMMUNITY COUNSELING & HOUSING SERVICES

Provider Business Mailing Address
First Line	:	4166 LINDELL BLVD APT 1B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2923
Country	:	US
Telephone Number	:	314-580-3029
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 SHEPLEY DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-4026
Country	:	US
Telephone Number	:	314-580-3029
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARVIN SHELTON
Credential	:	ED.S, ED.D, RADC-P
Telephone Number	:	314-580-3029

Provider Enumeration Date	:	02/08/2018
Last Update Date	:	04/17/2020

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