| Community Counseling Centers Inc | |
|
211 East Third Street Winslow AZ 86047-3802 | |
| (928) 289-4658 | |
| (928) 289-3775 |
| Full Name | Community Counseling Centers Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 211 East Third Street, Winslow, Arizona |
| Authorized Official Name and Position | Ivan Robert Wilderman (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9286246701 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Counseling Centers Inc 211 East Third Street Winslow AZ 86047-3802 Ph: (928) 289-4658 | Community Counseling Centers Inc 211 East Third Street Winslow AZ 86047-3802 Ph: (928) 289-4658 |
| NPI Number | 1669413175 |
|---|---|
| Provider Enumeration Date | 06/08/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669413175 | NPI | - | NPPES |
| 007452 | Other | AZ | AHCCCS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | BH141 (Arizona) | Primary |
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