Provider Demographics
NPI:1053687780
Name:COMMUNITY COUSELING CENTER, INC.
Entity Type:Organization
Organization Name:COMMUNITY COUSELING CENTER, INC.
Other - Org Name:GATEWOOD PLACE RCF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-258-2445
Mailing Address - Street 1:1700 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-4212
Mailing Address - Country:US
Mailing Address - Phone:405-528-2445
Mailing Address - Fax:405-528-2436
Practice Address - Street 1:1700 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-4212
Practice Address - Country:US
Practice Address - Phone:405-528-2445
Practice Address - Fax:405-528-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100728790-A320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness