MEDICARE: COMMUNITY COUNSELING CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609920784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COUNSELING CENTER

Provider Business Mailing Address
First Line	:	714 E SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2942
Country	:	US
Telephone Number	:	702-369-8700
Fax Number	:	702-369-8489

Provider Business Practice Location Address
First Line	:	714 E SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2942
Country	:	US
Telephone Number	:	702-369-8700
Fax Number	:	702-369-8489

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	THERESA A LUCERO
Credential	:
Telephone Number	:	702-369-8700

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/21/2022

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Directions to “COMMUNITY COUNSELING CENTER ” Practice Location

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