Provider Demographics
NPI:1043438310
Name:COWLITZ COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:COWLITZ COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, BCP
Authorized Official - Phone:360-414-5599
Mailing Address - Street 1:1952 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4045
Mailing Address - Country:US
Mailing Address - Phone:360-414-5599
Mailing Address - Fax:360-425-7531
Practice Address - Street 1:1952 9TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4045
Practice Address - Country:US
Practice Address - Phone:360-414-5599
Practice Address - Fax:360-425-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7900087Medicaid