Basic Information
| Provider Information | |||||||||
| NPI: | 1295082360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CC COUNSELING SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3445 S STATE ROUTE 291 | ||||||||
| Address2: | SUITE 300.1 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167951968 | ||||||||
| FaxNumber: | 8167957045 | ||||||||
| Practice Location | |||||||||
| Address1: | 3445 S STATE ROUTE 291 | ||||||||
| Address2: | SUITE 300.1 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167951968 | ||||||||
| FaxNumber: | 8167957045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2012 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | CURTIS | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8168726656 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2012010037 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.