Provider Demographics
NPI:1043246440
Name:CCST, LLC
Entity Type:Organization
Organization Name:CCST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-291-1499
Mailing Address - Street 1:2521 ELWOOD DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8229
Mailing Address - Country:US
Mailing Address - Phone:515-291-1499
Mailing Address - Fax:515-292-2184
Practice Address - Street 1:2521 ELWOOD DR
Practice Address - Street 2:SUITE 121
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8229
Practice Address - Country:US
Practice Address - Phone:515-291-1499
Practice Address - Fax:515-292-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA060441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA145 9909Medicaid
IA045 9909OtherIA MCAID ENT W DSM IA
IA36996OtherB CROSS B SHIELD WELLMARK
IA244574OtherMIDLANDS CHOICE
IA145 9909Medicaid