Harrison H Detroja, MSN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP60302056 Issued in WA

Practice address

720 14TH Ave
Longview, WA 98632-2315

Phone

(360) 423-0203

Fax

(360) 577-0187

NPI assigned

Aug 30, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Columbia WellnessGroup PAC ID 2567358286, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Columbia Wellness

  • Case Management Agency
  • Longview, WA
  • NPI 1487659579
  Medicare reassignment Care Compare group NPD
• Olympic Wellness PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lacey, WA
  • NPI 1861225724
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731715200000",
    "number": "1154670628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1847",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328140",
            "telephone_number": "360-423-0203",
            "fax_number": "360-577-0187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322315",
            "telephone_number": "360-423-0203",
            "fax_number": "360-577-0187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETROJA",
        "first_name": "HARRISON",
        "middle_name": "H",
        "name_prefix": "Mr.",
        "credential": "MSN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-30",
        "last_updated": "2024-11-16",
        "certification_date": "2024-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60302056",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60302056",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60302056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tori May Demyer, PHARMD
• Kathleen E Derby-Ray, MS, LMHCA
• Derenda Richardson
• Sara Derenge, ARNP
• Aleksis Desrosier
• David F Devidal, PHD
• Haley Dewitz, BS, R-AAC
• Anahita Deylamsalehi, MD
• Marlene L Dicristina, M.D.
• Gina Diem, LMP

• Psychiatric/Mental Health Nurse Practitioner in Longview, WA
• Providers in Longview, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.