Provider Demographics
NPI:1780854836
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:419-562-1296
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:419-562-1296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY COUNSELING SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0177251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9220681OtherMEDICARE
OH0177OtherODMH CERTIFICATION
OH1057OtherODMH MACSIS
OH2480748Medicaid