Provider Demographics
NPI:1619363223
Name:COMMUNITY COUNSELING CENTER OF ASHLAND
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING CENTER OF ASHLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-821-6623
Mailing Address - Street 1:600 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2140
Mailing Address - Country:US
Mailing Address - Phone:541-708-5436
Mailing Address - Fax:866-701-9131
Practice Address - Street 1:600 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2140
Practice Address - Country:US
Practice Address - Phone:541-708-5436
Practice Address - Fax:866-701-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty