Active NPI
Community Counseling Center
- Counselor
- Groves, TX
National Provider Identifier
1154323566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 18834
- Legal business name
- COMMUNITY COUNSELING CENTER
- Practice address
- 4757 Main Ave
Groves, TX 77619-4740 - Phone
- (409) 963-2331
- Fax
- (409) 963-2346
- NPI assigned
- Aug 15, 2005
- Last updated
- Aug 22, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Amber Malescha Derouen, MS, LPC
- Title
- Licensed Prof. Counselor/Therapist
- Phone
- (409) 963-2331
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 18834 | TX | Primary |
Addresses
Primary practice location
4757 Main Ave
Groves, TX 77619-4740
Mailing address
4757 Main Ave
Groves, TX 77619-4740
Phone (409) 963-2331
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164006202 | Medicaid | TX |
National Provider Directory
National Provider Directory- Tax ID family
- Community Counseling Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Community Counseling Center
- Mental Health Counselor
- Groves, TX
- NPI 1659587939
Locations
4757 Main Ave
Groves, TX 77619
Phone (409) 963-2331
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Mental Health Counselor
- Groves, TX
- NPI 1568677664
-
- Clinical Psychologist
- Marble Falls, TX
- NPI 1750319208
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124064000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1219363200000",
"number": "1154323566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4757 MAIN AVE",
"city": "GROVES",
"state": "TX",
"postal_code": "776194740",
"telephone_number": "409-963-2331",
"fax_number": "409-963-2346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4757 MAIN AVE",
"city": "GROVES",
"state": "TX",
"postal_code": "776194740",
"telephone_number": "409-963-2331",
"fax_number": "409-963-2346"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMMUNITY COUNSELING CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2005-08-15",
"last_updated": "2008-08-22",
"status": "A",
"authorized_official_last_name": "DEROUEN",
"authorized_official_first_name": "AMBER",
"authorized_official_middle_name": "MALESCHA",
"authorized_official_title_or_position": "LICENSED PROF. COUNSELOR/THERAPIST",
"authorized_official_telephone_number": "409-963-2331",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "MS, LPC"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "18834",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "164006202",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Groves, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.