Provider Demographics
NPI:1235224809
Name:COALITION OF COUNSELING CENTERS
Entity Type:Organization
Organization Name:COALITION OF COUNSELING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GLYN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-268-1146
Mailing Address - Street 1:13560 MESA DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949
Mailing Address - Country:US
Mailing Address - Phone:530-268-1146
Mailing Address - Fax:530-268-3636
Practice Address - Street 1:8321 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:916-726-4642
Practice Address - Fax:916-726-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3789103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty