Provider Demographics
NPI:1548561566
Name:COMMUNITY COUNSELING SOLUTIONS
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING SOLUTIONS
Other - Org Name:LAKEVIEW HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-676-9161
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:HEPPNER
Mailing Address - State:OR
Mailing Address - Zip Code:97836
Mailing Address - Country:US
Mailing Address - Phone:541-676-9161
Mailing Address - Fax:541-676-5662
Practice Address - Street 1:68982 WILLOW CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:HEPPNER
Practice Address - State:OR
Practice Address - Zip Code:97836
Practice Address - Country:US
Practice Address - Phone:541-676-5125
Practice Address - Fax:541-676-5186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY COUNSELING SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-08
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR300008320800000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274310Medicaid