Colby James Rezayat, LICSW, SUDPT, GMHS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61096339 Issued in WA

Practice address

816 N 15TH St
Mount Vernon, WA 98273-3417

Phone

(360) 421-2065

NPI assigned

Jul 9, 2014

Last updated

Nov 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Catholic Community Services of Western Washington

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Burlington, WA
  • NPI 1225449929
  NPD (past)
• Northwest Regional Council

  • Community/Behavioral Health Agency
  • Bellingham, WA
  • NPI 1093284374
  NPD (past)

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1447666532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 N 15TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982733417",
            "telephone_number": "360-421-2065",
            "fax_number": "360-757-0136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 N 15TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982733417",
            "telephone_number": "360-421-2065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "614 Peterson Rd",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "WA",
            "postal_code": "982332606",
            "country_code": "US",
            "telephone_number": "360-757-0131",
            "fax_number": "360-757-0136",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "811 Madison St",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982034543",
            "country_code": "US",
            "telephone_number": "425-212-4285",
            "fax_number": "425-293-0785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REZAYAT",
        "first_name": "COLBY",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "LICSW, SUDPT, GMHS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-09",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61096339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fred H. Renco, PA-C
• Amanda M Rentschler, DMD
• Elizabeth E. Repplier, MD
• Lynn Margaret Retzer, M.ED
• Pedro Junior Reyes
• Richard Simcock DDS, PS
• Ruth E Richmond, OTR-L
• Melissa Rienstra
• Donna Estelle Rieper
• Rindal Chiropractic Clinic, P.S.

• Clinical Social Worker in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.