Healthcare Provider Details

I. General information

NPI: 1922066463
Provider Name (Legal Business Name): COLUMBIA COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58646 MCNULTY WAY
SAINT HELENS OR
97051-6210
US

IV. Provider business mailing address

58646 MCNULTY WAY
SAINT HELENS OR
97051-6210
US

V. Phone/Fax

Practice location:
  • Phone: 503-397-5211
  • Fax: 503-397-5373
Mailing address:
  • Phone: 503-397-5211
  • Fax: 503-397-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TODD JACOBSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 503-397-5211