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General NPI Number Information
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NPI Number | 1538412630
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Entity Type | Organization
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Legal Business Name | COWLITZ INDIAN TRIBE
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Dates
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Enumeration Date | 10/26/2012
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 7105 NE 40TH ST
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City | VANCOUVER
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State | WA
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Zip | 98661-3058
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Country | US
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Telephone | 360-353-9431
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Fax | 360-353-9440
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Provider Business Mailing Address
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Address Line | PO BOX 2429
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City | LONGVIEW
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State | WA
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Zip | 98632-8486
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Country | US
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Telephone | 206-721-5170
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Fax | 206-721-6288
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | SHAVON KELLER
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Credential |
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Telephone | 360-353-9431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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