Basic Information
| Provider Information | |||||||||
| NPI: | 1851796247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLATSOP BEHAVIORAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 EXCHANGE ST | ||||||||
| Address2: | 301 | ||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033255722 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 N HIGHWAY 101 STE 204 | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971469371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033255722 | ||||||||
| FaxNumber: | 5038612043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2014 | ||||||||
| LastUpdateDate: | 10/31/2018 | ||||||||
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| AuthorizedOfficialLastName: | SAXON | ||||||||
| AuthorizedOfficialFirstName: | JIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | IT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5033250241 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.