Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
COMMUNITY COUNSELING CENTERS INC
Active
Organization
COMMUNITY COUNSELING CENTERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN ROBERT WILDERMAN PH D (CHIEF EXECUTIVE OFFICER)
(928) 624-6701
Entity
Organization
Contact information
Practice address
211 EAST THIRD STREET, WINSLOW, AZ 86047-3802
(928) 289-4658
(928) 289-3775
Mailing address
211 EAST THIRD STREET, WINSLOW, AZ 86047-3802
(928) 289-4658
(928) 289-3775
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
BH141
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007452
AHCCCS
AZ
Enumeration date
06/08/2006
Last updated
08/22/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up