Healthcare Provider Details

I. General information

NPI: 1427277425
Provider Name (Legal Business Name): WAHKIAKUM COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 ELOCHOMAN VALLEY ROAD
CATHLAMET WA
98612
US

IV. Provider business mailing address

42 ELOCHOMAN VALLEY ROAD
CATHLAMET WA
98612
US

V. Phone/Fax

Practice location:
  • Phone: 360-795-8630
  • Fax: 360-795-6224
Mailing address:
  • Phone: 360-795-8630
  • Fax: 360-795-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWA

VIII. Authorized Official

Name: MR. CHRIS A BISCHOFF
Title or Position: WAHKIAKUM COUNTY HEALTH & HUMAN SER
Credential: MSML, RS/REHS
Phone: 360-795-6207