Healthcare Provider Details

I. General information

NPI: 1295324135
Provider Name (Legal Business Name): OHANA COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 THREE RIVERS DR STE 166
KELSO WA
98626-3125
US

IV. Provider business mailing address

717 NE 61ST ST STE 202
VANCOUVER WA
98665-8756
US

V. Phone/Fax

Practice location:
  • Phone: 360-909-5762
  • Fax:
Mailing address:
  • Phone: 360-718-6548
  • Fax: 360-718-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANSON SERVICE
Title or Position: OWNER
Credential: LMHC
Phone: 360-909-5762