Organization
COMMUNITY COUNSELING CENTERS INC
Active
Other names
Pine View Behavioral Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN ROBERT WILDERMAN PHD (CHIEF EXECUTIVE OFFICER)
(928) 524-6701
Entity
Organization
Contact information
Practice address
2550 SHOW LOW LAKE ROAD, SHOW LOW, AZ 85901-7929
(928) 537-1029
(928) 537-9049
Mailing address
2550 SHOW LOW LAKE ROAD, SHOW LOW, AZ 85901-7929
(928) 537-1029
(928) 537-9049
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
590142
AHCCCS
AZ
Enumeration date
07/13/2006
Last updated
08/22/2020
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