NPIMap

Organization Active NPI

The Community Counseling & Housing Services

  • Assisted Living Facility (Mental Illness)
  • Jennings, MO
National Provider Identifier
1477052058
Registry record updated Feb 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
Legal business name
THE COMMUNITY COUNSELING & HOUSING SERVICES
Practice address
2407 Petrova Ave
Jennings, MO 63136-3903
Phone
(314) 580-3029
NPI assigned
Feb 8, 2018
Last updated
Feb 8, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marvin Shelton, ED.S, ED.D, RADC-PNPI 1003364969
Title
Ceo
Phone
(314) 580-3029

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Case Management Agency 251B00000X
In Home Supportive Care Agency 253Z00000X
VA Clinic/Center 261QV0200X
Assisted Living Facility (Mental Illness) 3104A0625X Primary
Assisted Living Facility (Behavioral Disturbances) 3104A0630X
Psychiatric Residential Treatment Facility 323P00000X
Substance Abuse Rehabilitation Facility 324500000X
Managed Care Organization Pharmacy 3336M0003X

Addresses

Primary practice location

2407 Petrova Ave
Jennings, MO 63136-3903

Mailing address

4166 Lindell Blvd Apt 1B
Saint Louis, MO 63108-2923
Phone (314) 580-3029

Other names 1

  • THE PETROVA HOUSE Other name

National Provider Directory

National Provider Directory
Tax ID family
The Community Counseling Housing Services8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518048000000",
    "number": "1477052058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4166 LINDELL BLVD APT 1B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082923",
            "telephone_number": "314-580-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 PETROVA AVE",
            "city": "JENNINGS",
            "state": "MO",
            "postal_code": "631363903",
            "telephone_number": "314-580-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COMMUNITY COUNSELING & HOUSING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-08",
        "last_updated": "2018-02-08",
        "status": "A",
        "authorized_official_last_name": "SHELTON",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-580-3029",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.S, ED.D, RADC-P"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE PETROVA HOUSE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jennings, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.