Provider Demographics
NPI:1609920784
Name:COMMUNITY COUNSELING CENTER
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-369-8700
Mailing Address - Street 1:714 E SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-2942
Mailing Address - Country:US
Mailing Address - Phone:702-369-8700
Mailing Address - Fax:702-369-8489
Practice Address - Street 1:714 E SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2942
Practice Address - Country:US
Practice Address - Phone:702-369-8700
Practice Address - Fax:702-369-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508255Medicaid
NV100508258Medicaid
NV100508254Medicaid
NV100509187Medicaid
NV100509188Medicaid
NV100504583Medicaid
NV100508257Medicaid