Provider Demographics
NPI:1083189401
Name:COMMUNITY CONNECTIONS, LLC OUTPATIENT CLINIC
Entity Type:Organization
Organization Name:COMMUNITY CONNECTIONS, LLC OUTPATIENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-509-5248
Mailing Address - Street 1:9208 N 83RD PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1884
Mailing Address - Country:US
Mailing Address - Phone:602-509-5248
Mailing Address - Fax:
Practice Address - Street 1:4025 W BELL RD STE 6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2748
Practice Address - Country:US
Practice Address - Phone:602-509-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CONNECTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicaid