| Cowlitz Indian Tribal Health Services | |
|
1044 11th Ave Longview WA 98632-2506 | |
| (360) 575-8275 | |
| (360) 575-1948 |
| Full Name | Cowlitz Indian Tribal Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 1044 11th Ave, Longview, Washington |
| Authorized Official Name and Position | Shavon Keller (BILLING SUPERVISOR) |
| Authorized Official Contact | 3603539431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cowlitz Indian Tribal Health Services Po Box 2429 Longview WA 98632-8486 Ph: (360) 575-8275 | Cowlitz Indian Tribal Health Services 1044 11th Ave Longview WA 98632-2506 Ph: (360) 575-8275 |
| NPI Number | 1740562909 |
|---|---|
| Provider Enumeration Date | 09/14/2011 |
| Last Update Date | 03/22/2018 |
| Medicare PECOS PAC ID | 8820030133 |
|---|---|
| Medicare Enrollment ID | O20050526000589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740562909 | NPI | - | NPPES |
| 7122898 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
| Provider Name | Amos C Chen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245526946 PECOS PAC ID: 0547439796 Enrollment ID: I20110804000733 |
| Provider Name | Masha N Fry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992035976 PECOS PAC ID: 8921232596 Enrollment ID: I20131015000274 |
| Provider Name | Amanda Weigle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588041420 PECOS PAC ID: 2163743253 Enrollment ID: I20150601002156 |
| Provider Name | Tavis J Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043207020 PECOS PAC ID: 0840350849 Enrollment ID: I20160203000208 |
| Provider Name | Lynsey R Dearth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760733703 PECOS PAC ID: 8921302100 Enrollment ID: I20160209000646 |
| Provider Name | Tara L Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720637424 PECOS PAC ID: 2365864832 Enrollment ID: I20200630000928 |
| Provider Name | Cesario A Garcia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124446737 PECOS PAC ID: 7810391901 Enrollment ID: I20210811003616 |
| Provider Name | Sandra S Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629561634 PECOS PAC ID: 6406244789 Enrollment ID: I20211020000489 |
| Provider Name | Jennifer L Fresh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760845853 PECOS PAC ID: 8820487192 Enrollment ID: I20211109000619 |
| Provider Name | Kahanu J Kahoonei |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215600697 PECOS PAC ID: 7810389848 Enrollment ID: I20220124002257 |
| Provider Name | Melissa A Helgeson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093364242 PECOS PAC ID: 0941638886 Enrollment ID: I20220509000103 |
| Provider Name | Tate J Bates |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689150997 PECOS PAC ID: 9537543327 Enrollment ID: I20220827000591 |
| Provider Name | Megan M Nussbaum |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1831520386 PECOS PAC ID: 3274904826 Enrollment ID: I20230119000657 |
| Provider Name | Jennifer T Hardgrove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033757067 PECOS PAC ID: 6103233861 Enrollment ID: I20230724003004 |
| Provider Name | Cassie D Hummel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770295586 PECOS PAC ID: 1355798000 Enrollment ID: I20231117000285 |
| Provider Name | Clint M Thompson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427405034 PECOS PAC ID: 3779875968 Enrollment ID: I20231125000029 |
| Provider Name | Maegan R Bolin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558804997 PECOS PAC ID: 5193174407 Enrollment ID: I20231212003244 |
| Provider Name | Marissa N Moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750703898 PECOS PAC ID: 2961851126 Enrollment ID: I20231213001342 |
| Provider Name | Santana M Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881181063 PECOS PAC ID: 3870977325 Enrollment ID: I20231213001964 |
| Provider Name | Sheryl D Whitlinger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235417007 PECOS PAC ID: 9931559424 Enrollment ID: I20231226000342 |
| Provider Name | Denise L Tagas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982934378 PECOS PAC ID: 1759731243 Enrollment ID: I20231226000351 |
| Provider Name | Allison L Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629462726 PECOS PAC ID: 9830549328 Enrollment ID: I20231226000362 |
| Provider Name | Virginia Hemming |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568703932 PECOS PAC ID: 1658721147 Enrollment ID: I20231226000368 |
| Provider Name | Kimberly Lacy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215248877 PECOS PAC ID: 5890145130 Enrollment ID: I20231228001240 |
| Provider Name | Breanna L Peter |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1235669250 PECOS PAC ID: 0749631547 Enrollment ID: I20240105001551 |
| Provider Name | Korrie L Kashuba |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740653989 PECOS PAC ID: 4880045681 Enrollment ID: I20240105001726 |
| Provider Name | Lesley B Roberts Cauldron |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487082814 PECOS PAC ID: 6204287972 Enrollment ID: I20240106000208 |
| Provider Name | Celia A Delaney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033508064 PECOS PAC ID: 4486006525 Enrollment ID: I20240115000251 |
| Provider Name | David A Pulliam |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063787216 PECOS PAC ID: 3173966173 Enrollment ID: I20240207000173 |
| Provider Name | Maytal C Grossman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1598022584 PECOS PAC ID: 0941644678 Enrollment ID: I20240221000758 |
| Provider Name | Joy L Graves |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1902052640 PECOS PAC ID: 1951747294 Enrollment ID: I20240308003766 |
Lance D Brigman, Md, Ps Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1004 Fir St, Longview, WA 98632 Phone: 360-423-6110 Fax: 360-423-8078 | |
Cowlitz Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1057 12th Ave, Longview, WA 98632 Phone: 360-636-3892 Fax: 360-414-1114 | |
Prov Peds Neurology Longview Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 971 11th Ave, Longview, WA 98632 Phone: 360-577-1771 | |
Longview Clinic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 820 11th Ave, Longview, WA 98632 Phone: 360-423-6626 Fax: 360-423-6626 | |
Ideal Option, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1146 14th Ave, Longview, WA 98632 Phone: 877-522-1275 Fax: 509-491-3031 | |
Kidspace Therapy, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2145 Tibbetts Dr Ste A, Longview, WA 98632 Phone: 360-560-1972 Fax: 360-703-3452 | |
Cowlitz Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1057 12th Ave, Longview, WA 98632 Phone: 360-636-3892 Fax: 360-414-1114 |