Provider Demographics
NPI:1326444613
Name:CCI THERAPY -COUNSELING CENTERS INTERNATIONAL
Entity Type:Organization
Organization Name:CCI THERAPY -COUNSELING CENTERS INTERNATIONAL
Other - Org Name:C.C.I. THERAPY COUNSELING CENTERS INTERNATIONAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIAQUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-423-2000
Mailing Address - Street 1:908 PAREDES LINE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2660
Mailing Address - Country:US
Mailing Address - Phone:956-982-0082
Mailing Address - Fax:
Practice Address - Street 1:908 PAREDES LINE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2660
Practice Address - Country:US
Practice Address - Phone:956-982-0082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65943101Y00000X
101YP2500X, 111N00000X, 207Q00000X, 2084N0400X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401546301Medicaid