Provider Demographics
NPI:1922127133
Name:COMMUNITY COUNSELING SERVICES
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:POLLITT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:660-827-9875
Mailing Address - Street 1:1721 SO. INGRAM
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301
Mailing Address - Country:US
Mailing Address - Phone:660-827-9875
Mailing Address - Fax:660-827-9879
Practice Address - Street 1:1721 S INGRAM AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7535
Practice Address - Country:US
Practice Address - Phone:660-827-9875
Practice Address - Fax:660-827-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495376816Medicaid