Healthcare Provider Details

I. General information

NPI: 1669823589
Provider Name (Legal Business Name): DANIEL JAY COLON MSW, MHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

IV. Provider business mailing address

104 NW 103RD ST
VANCOUVER WA
98685-4311
US

V. Phone/Fax

Practice location:
  • Phone: 360-450-7976
  • Fax:
Mailing address:
  • Phone: 503-719-1309
  • Fax: 360-397-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60673709
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: