Healthcare Provider Details

I. General information

NPI: 1518563386
Provider Name (Legal Business Name): CHERYL TERESE RUBENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 09/16/2024
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SIMPSON AVE STE 101
ABERDEEN WA
98520
US

IV. Provider business mailing address

COLUMBIA WELLNESS PO BOX 1847
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 360-612-0012
  • Fax: 360-532-0670
Mailing address:
  • Phone: 360-353-9369
  • Fax: 360-577-0187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61604893
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: