Provider Demographics
NPI:1013925155
Name:CLATSOP BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:CLATSOP BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-325-0241
Mailing Address - Street 1:65 N HWY 101 SUITE 204
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146
Mailing Address - Country:US
Mailing Address - Phone:503-325-0241
Mailing Address - Fax:503-861-2043
Practice Address - Street 1:65 N HWY 101 SUITE 204
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-325-0241
Practice Address - Fax:503-861-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X, 251B00000X, 251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR030494Medicaid
OR500634477Medicaid
OR500634477Medicaid
OR0000WCGRPMedicare ID - Type Unspecified