NPIMap

Organization Active NPI

Community House on Broadway

  • Mental Health Counselor
  • Longview, WA
National Provider Identifier
1467855353
Registry record updated Oct 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
313 Issued in WA
Legal business name
COMMUNITY HOUSE ON BROADWAY
Practice address
748 14TH Ave
Longview, WA 98632-2315
Phone
(360) 200-5419
NPI assigned
Oct 6, 2014
Last updated
Oct 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2015

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

Authorized official

Name
Mr. Cameron Carson
Title
Clinic Manager
Phone
(360) 200-5419

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 313 WA Primary

Addresses

Primary practice location

748 14TH Ave
Longview, WA 98632-2315

Mailing address

PO Box 403
Longview, WA 98632-7260
Phone (360) 200-5419

National Provider Directory

National Provider Directory
Tax ID family
Community House on Broadway2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1467855353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 403",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986327260",
            "telephone_number": "360-200-5419",
            "fax_number": "360-200-6736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "748 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322315",
            "telephone_number": "360-200-5419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOUSE ON BROADWAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-06",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "360-200-5419",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.