Provider Demographics
NPI:1669448544
Name:COMMUNITY COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIPES
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:419-562-2000
Mailing Address - Street 1:2458 STETZER RD
Mailing Address - Street 2:PO BOX 765
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2066
Mailing Address - Country:US
Mailing Address - Phone:419-562-2000
Mailing Address - Fax:
Practice Address - Street 1:2458 STETZER RD
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2066
Practice Address - Country:US
Practice Address - Phone:419-562-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1057261Q00000X
OH0177261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444653Medicaid
OH1057OtherODADAS CERTIFICATE NUMBER
OH0177OtherODMH CERTIFICATE NUMBER
OH0177OtherODMH CERTIFICATE NUMBER