MEDICARE: COWLITZ COMMUNITY BEHAVIORAL HEALTH CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1376408476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COWLITZ COMMUNITY BEHAVIORAL HEALTH CENTERS

Provider Business Mailing Address
First Line	:	8 SCHONERT PL
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-5616
Country	:	US
Telephone Number	:	360-562-7971
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 SCHONERT PL
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-5616
Country	:	US
Telephone Number	:	360-562-7971
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHAWNA RAELYNN DESPAIN
Credential	:	AAC
Telephone Number	:	360-562-7971

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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