OrganizationActive
Community Counseling Centers Inc
NPI 1669413175 · Mental Health Clinic/Center (Including Community Mental Health Center) · Winslow, AZ
Provider details
- NPI number
- 1669413175
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Ivan Wilderman, Chief Executive Officer(928) 624-6701
- License
- BH141 (AZ)
Specialties & taxonomies
- Mental Health Clinic/Center (Including Community Mental Health Center)Primary261QM0801XLicense BH141 (AZ)
Ambulatory Health Care Facilities
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
211 East Third Street
Winslow, AZ 86047-3802
Phone: (928) 289-4658
Fax: (928) 289-3775
Street-level locationGet directions
Mailing address
211 East Third Street
Winslow, AZ 86047-3802
Registry dates
- Enumerated
- 2006-06-08
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.