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General NPI Number Information
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NPI Number | 1922040526
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Entity Type | Organization
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Legal Business Name | BLUE MOUNTAIN COUNSELING OF COLUMBIA COUNTY
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 02/02/2014
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Provider Practice Location Address
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Address Line | 221 E WASHINGTON AVE
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City | DAYTON
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State | WA
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Zip | 99328-1317
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Country | US
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Telephone | 509-382-1164
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Fax | 509-382-1166
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Provider Business Mailing Address
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Address Line | 221 E WASHINGTON AVE
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City | DAYTON
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State | WA
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Zip | 99328-1317
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Country | US
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Telephone | 509-382-1164
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Fax | 509-382-1166
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Authorized Official
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Title or Position | DIRECTOR
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Name | DIMITA WARREN
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Credential | BA
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Telephone | 509-382-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 223
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | G8809077
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License Number State | WA
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