Provider Demographics
NPI:1881878494
Name:COMMUNITY CLINIC CENTER, LTD
Entity type:Organization
Organization Name:COMMUNITY CLINIC CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:815-338-7749
Mailing Address - Street 1:666 RUSSEL CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-2670
Mailing Address - Country:US
Mailing Address - Phone:815-338-7749
Mailing Address - Fax:815-338-7728
Practice Address - Street 1:666 RUSSEL CT
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-2670
Practice Address - Country:US
Practice Address - Phone:815-338-7749
Practice Address - Fax:815-338-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)