Provider Demographics
NPI:1831125293
Name:COMMUNITY COUNSELING AND PSYCHOTHERAPY LTD
Entity type:Organization
Organization Name:COMMUNITY COUNSELING AND PSYCHOTHERAPY LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZEGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-996-8619
Mailing Address - Street 1:11020 N TATUM BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3841
Mailing Address - Country:US
Mailing Address - Phone:602-996-8619
Mailing Address - Fax:602-996-7932
Practice Address - Street 1:11020 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3841
Practice Address - Country:US
Practice Address - Phone:602-996-8619
Practice Address - Fax:602-996-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW00261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78336Medicare ID - Type Unspecified
AZ78336Medicare PIN