Community Counseling Clinic LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

COMMUNITY COUNSELING CLINIC LLC

Practice address

2642 Main St
Union Gap, WA 98903-1752

Phone

(509) 452-6546

Fax

(509) 452-6965

NPI assigned

Feb 27, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Carolyn Kay Fries

Title

Administrator Sr Member

Phone

(509) 452-6546

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942337076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3036",
            "city": "UNION GAP",
            "state": "WA",
            "postal_code": "989030036",
            "telephone_number": "509-452-6546",
            "fax_number": "509-452-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2642 MAIN ST",
            "city": "UNION GAP",
            "state": "WA",
            "postal_code": "989031752",
            "telephone_number": "509-452-6546",
            "fax_number": "509-452-6965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY COUNSELING CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRIES",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "ADMINISTRATOR SR MEMBER",
        "authorized_official_telephone_number": "509-452-6546",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "A7570",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "7500CO",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1995448",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DARRELL G FRIES CDP",
            "identifier": "CP00002903",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Union Gap, WA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.