Provider Demographics
NPI:1427319474
Name:COMMUNITY COUNSELING & CRISIS CENTER
Entity type:Organization
Organization Name:COMMUNITY COUNSELING & CRISIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:BUTLER FINGERHUT
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:513-523-4149
Mailing Address - Street 1:110 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1738
Mailing Address - Country:US
Mailing Address - Phone:513-523-4149
Mailing Address - Fax:513-523-4145
Practice Address - Street 1:110 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1738
Practice Address - Country:US
Practice Address - Phone:513-523-4149
Practice Address - Fax:513-523-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2863932Medicaid