Community Counseling Center, LTD.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

COMMUNITY COUNSELING CENTER, LTD.

Practice address

666 Russel CT
105
Woodstock, IL 60098-2670

Phone

(815) 338-7749

Fax

(815) 338-7728

NPI assigned

Apr 1, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Martin

Title

President

Phone

(815) 338-7749

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1175385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972623833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "666 RUSSEL CT",
            "address_2": "105",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600982670",
            "telephone_number": "815-338-7749",
            "fax_number": "815-338-7728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "666 RUSSEL CT",
            "address_2": "105",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600982670",
            "telephone_number": "815-338-7749",
            "fax_number": "815-338-7728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY COUNSELING CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-338-7749",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "05630307",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Maureen Tan Clam, PT
• Sarah Elizabeth Clark, LPC
• Phetsavanh Coggin, LCPC
• Community Chiropractic Center Woodstock SC
• Community Clinic Center, LTD
• Community Health Partnership of Illinois
• Timothy D Conway, DDS
• Richard O Cook, MD
• Evone Kay Coombs, MA, LCPC
• Kathleen Ann Cooper, MS, CCC-SLP

• Community/Behavioral Health Agency in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Community/Behavioral Health Agency in Illinois

• 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.