Provider Demographics
NPI:1760431589
Name:COMMUNITY COUNSELING AND CRISIS CENTER
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING AND CRISIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-523-4149
Mailing Address - Street 1:110 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1738
Mailing Address - Country:US
Mailing Address - Phone:513-523-4149
Mailing Address - Fax:513-523-4145
Practice Address - Street 1:110 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1738
Practice Address - Country:US
Practice Address - Phone:513-523-4149
Practice Address - Fax:513-523-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000005073OtherANTHEM BC/BS
OH185955000OtherMAGELLAN BEHAVIORAL
IN200026690AMedicaid
OH185955000OtherMAGELLAN BEHAVIORAL