Provider Demographics
NPI:1124398896
Name:COMMUNITY COUNSELING SERVICES
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KOLTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:956-343-1439
Mailing Address - Street 1:11360 WEST LACOMA COUNTY ROAD
Mailing Address - Street 2:
Mailing Address - City:LYFORD
Mailing Address - State:TX
Mailing Address - Zip Code:78569
Mailing Address - Country:US
Mailing Address - Phone:956-343-1439
Mailing Address - Fax:956-347-3182
Practice Address - Street 1:11360 WEST LACOMA ROAD
Practice Address - Street 2:
Practice Address - City:LYFORD
Practice Address - State:TX
Practice Address - Zip Code:78569
Practice Address - Country:US
Practice Address - Phone:956-343-1439
Practice Address - Fax:956-347-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19782261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179375401Medicaid