COWLITZ TRIBAL TREATMENT - NPI 1164649679 - Clinic/Center in Vancouver, WA

Q: What is Cowlitz Indian Tribe's NPI number?

The NPI number for Cowlitz Indian Tribe is 1164649679. It was assigned to this organization in the NPPES registry on April 19, 2007. The provider is also known as Cowlitz Tribal Treatment.

Q: What is Cowlitz Indian Tribe's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.

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About Cowlitz Tribal Treatment NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COWLITZ TRIBAL TREATMENT (NPI 1164649679) is a healthcare organization registered as a rehabilitation, substance use disorder in Vancouver, Washington and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through April 4, 2028, maintains a secondary practice location in Longview, and lists Shavon Keller, Billing Supervisor, as its authorized official.

NPPES Registry Identity

NPI1164649679

Entity TypeOrganization

Primary Taxonomy261QR0405X

Legal Business NameCOWLITZ INDIAN TRIBE

Location Address7700 NE 26TH AVEVancouver, WA 98665-0672

Mailing AddressP.o. Box 2429Longview, WA 98632 · (360) 397-8228 · Fax (360) 575-1950

Phone(360) 397-8228

Fax(360) 575-1950

Organization SubpartYes

Authorized OfficialShavon KellerBilling Supervisor · (360) 353-9431

Enumeration DateApril 19, 2007

Last NPPES UpdateJuly 22, 20245 updates tracked since enumeration

NPPES CertifiedJuly 22, 2024

✔ NPI 1164649679 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Rehabilitation, Substance Use DisorderAmbulatory Health Care Facilities

Taxonomy Code261QR0405X

Also ListedGeneral PracticeTaxonomy 208D00000X

7700 NE 26TH AVE, Vancouver, WA 98665

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Other Names 1

Other NameCowlitz Tribal Treatment

Secondary Practice Location 1

Location 1900 Fir StLongview, WA 98632-2544 · Phone (360) 575-3316

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Oregon.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2229759

Cowlitz Indian Tribe · Vancouver, WA

Active · expires Apr 4, 2028

CLIA Number50D2229759

Laboratory TypeDrug Treatment

Certificate Effective DateJuly 15, 2021

Certificate Expiration DateApril 4, 2028

Laboratory DirectorLori Ryan

Laboratory Phone(360) 397-8228

Laboratory LocationCowlitz Indian Tribe7700 NE 26th Ave, Vancouver, WA 98665

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAVID ALDEN PULLIAM LMHC

Counselor (Mental Health)