Provider Demographics
NPI:1912055161
Name:COMMUNITY COUNSELING GROUP
Entity type:Organization
Organization Name:COMMUNITY COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-373-1033
Mailing Address - Street 1:PO BOX 7178
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7178
Mailing Address - Country:US
Mailing Address - Phone:805-373-1033
Mailing Address - Fax:805-373-1032
Practice Address - Street 1:3625 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE #109
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3626
Practice Address - Country:US
Practice Address - Phone:805-373-1033
Practice Address - Fax:805-373-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-13901103T00000X
CAPSY-17349103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP17349AMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
CAW19498Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
CAWCP 13901AMedicare ID - Type UnspecifiedMEDICARE ID NUMBER