Healthcare Provider Details

I. General information

NPI: 1669411377
Provider Name (Legal Business Name): COLUMBIA RIVER MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6926 NE FOURTH PLAIN BLVD
VANCOUVER WA
98661-7254
US

IV. Provider business mailing address

6926 NE FOURTH PLAIN BLVD
VANCOUVER WA
98661-7254
US

V. Phone/Fax

Practice location:
  • Phone: 360-993-3000
  • Fax: 360-993-3099
Mailing address:
  • Phone: 360-993-3000
  • Fax: 360-993-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number067
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number06 0894 00
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number138
License Number StateWA

VIII. Authorized Official

Name: DANIEL SMITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSW
Phone: 503-459-6495