Provider Demographics
NPI:1164756565
Name:CCPCS
Entity Type:Organization
Organization Name:CCPCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-776-7792
Mailing Address - Street 1:305 LONDONDERRY DR STE 7
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7906
Mailing Address - Country:US
Mailing Address - Phone:254-776-7792
Mailing Address - Fax:254-776-0577
Practice Address - Street 1:305 LONDONDERRY DR STE 7
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7906
Practice Address - Country:US
Practice Address - Phone:254-776-7792
Practice Address - Fax:254-776-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-5171251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health