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COWLITZ INDIAN TRIBAL HEALTH SERVICES
NPI 1619194123
Preventive Medicine - Public Health & General Preventive Medicine in Longview, WA

Active since April 19, 2007CLIA Certified · 2 labs
900 FIR ST, LONGVIEW, WA 98632(360) 353-9422 Get Directions Write a Review

NPPES record last updated: October 31, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Feb 3, 2023, Jul 16, 2018, Mar 22, 2018 and 2 more (5 updates tracked since 2016).

About Cowlitz Indian Tribal Health Services NPPES

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

COWLITZ INDIAN TRIBAL HEALTH SERVICES (NPI 1619194123) is a healthcare organization registered as a public health & general preventive medicine in Longview, Washington and active in the NPI registry since April 2007. The organization holds 2 active CLIA laboratory certificates, maintains 5 additional practice locations, and lists Shavon Keller, Billing Supervisor, as its authorized official.

NPPES Registry Identity

NPI1619194123
Entity TypeOrganization
Primary Taxonomy2083P0901X
Legal Business NameCOWLITZ INDIAN TRIBE
Location Address900 FIR STLongview, WA 98632-2544
Mailing AddressPo Box 2429Longview, WA 98632-8486 · (360) 575-8275 · Fax (360) 575-1950
Phone(360) 353-9422
Organization SubpartYes
Authorized OfficialShavon KellerBilling Supervisor · (360) 353-9431
Enumeration DateApril 19, 2007
Last NPPES UpdateOctober 31, 20245 updates tracked since enumeration
NPPES CertifiedOctober 31, 2024
✔ NPI 1619194123 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPreventive Medicine · Public Health & General Preventive MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2083P0901X
Definition
Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings.
Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X
Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X
900 FIR ST, Longview, WA 98632
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Other Names 1

Other NameCowlitz Indian Tribal Health Services

Secondary Practice Locations 5

Location 11044 11th Ave, Suite ALongview, WA 98632-2506 · Phone (360) 575-8275 · Fax (360) 575-1950
Location 27700 NE 26th AveVancouver, WA 98665-0672 · Phone (360) 397-8228
Location 36450 Southcenter BlvdTukwila, WA 98188-2552 · Phone (206) 466-5410
Location 415455 65th Ave STukwila, WA 98188-2534 · Phone (206) 721-5170
Location 51000 Davis PlDuPont, WA 98327-8781 · Phone (360) 946-2498

Other Identifiers 1

Medicaid1981224WA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

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 50D2207612

Cowlitz Indian Tribe Behavioral Health Services · Tukwila, WA
Active · expires Apr 4, 2028
CLIA Number50D2207612
Laboratory TypePhysician Office
Certificate Effective DateDecember 29, 2020
Certificate Expiration DateApril 4, 2028
Laboratory DirectorAmos Chen
Laboratory Phone(206) 466-5410
Laboratory LocationCowlitz Indian Tribe Behavioral Health Services6450 Southcenter Blvd Ste 102, Tukwila, WA 98188
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 50D2292544

Cowlitz Indian Tribe Behavioral Health Services · Longview, WA
Active · expires Apr 4, 2028
CLIA Number50D2292544
Laboratory TypeBh Outpatient
Certificate Effective DateOctober 26, 2023
Certificate Expiration DateApril 4, 2028
Laboratory DirectorJennifer Fresh
Laboratory Phone(360) 353-9422
Laboratory LocationCowlitz Indian Tribe Behavioral Health Services900 Fir St, Longview, WA 98632
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 20

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

CASSIDY ROBERTS
Peer Specialist
900 FIR ST
LONGVIEW, WA 98632
Cowlitz County (360) 353-9422
MRS. ANGELA NAILLON MA
Marriage & Family Therapist
900 FIR ST
LONGVIEW, WA 98632
Cowlitz County (360) 353-9422
HEATHER MARIE KRAFT CG 61090134
Peer Specialist
900 FIR ST
LONGVIEW, WA 98632
Cowlitz County (360) 575-3316
JESSE CHO
Nurse Practitioner (Psychiatric/Mental Health)
900 FIR ST
LONGVIEW, WA 98632
Cowlitz County (949) 878-8315
KYLEE BROOK LANCASTER SUDP-T
Counselor (Addiction (Substance Use Disorder))
900 FIR ST
LONGVIEW, WA 98632
Cowlitz County (360) 353-9422
MRS. MIRANDA JAKSHA SUDP-T
Counselor (Addiction (Substance Use Disorder))
900 FIR ST
LONGVIEW, WA 98632
Cowlitz County (360) 353-9422
TYLER WILLIAM STOCKTON CDPT
Counselor (Addiction (Substance Use Disorder))
900 FIR ST
LONGVIEW, WA 98632
Cowlitz County (360) 575-3316
MRS. ANGELA LYNN MITCHELL SUDP, LICSWA
Counselor (Addiction (Substance Use Disorder))
900 FIR ST
LONGVIEW, WA 98632
Cowlitz County (360) 575-3316

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cowlitz Indian Tribe's NPI number?

The NPI number for Cowlitz Indian Tribe is 1619194123. It was assigned to this organization in the NPPES registry on April 19, 2007. The provider is also known as Cowlitz Indian Tribal Health Services.

Where is Cowlitz Indian Tribe located?

Cowlitz Indian Tribe is located at 900 Fir St, Longview, WA 98632. The listed phone number is (360) 353-9422.

What is Cowlitz Indian Tribe's specialty?

The primary specialty registered for this NPI is Preventive Medicine, specializing in Public Health & General Preventive Medicine, with taxonomy code 2083P0901X.

Does Cowlitz Indian Tribe hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Cowlitz Indian Tribe was last updated on October 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.