MEDICARE: COLUMBIA BEHAVIORAL HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1760270318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	11490 COMMERCE PARK DR STE 500
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-1532
Country	:	US
Telephone Number	:	703-337-3116
Fax Number	:

Provider Business Practice Location Address
First Line	:	11490 COMMERCE PARK DR STE 500
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-1532
Country	:	US
Telephone Number	:	703-337-3116
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDER KANAAN
Credential	:	NURSE PRACTITIONER
Telephone Number	:	727-400-1951

Provider Enumeration Date	:	04/25/2025
Last Update Date	:	03/05/2026

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