Provider Demographics
| NPI: | 1427766757 |
|---|---|
| Name: | KLICKITAT COUNTY BEHAVIORAL HEALTH |
| Entity type: | Organization |
| Organization Name: | KLICKITAT COUNTY BEHAVIORAL HEALTH |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR, BEHAVIORAL HEALTH |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ERINN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | QUINN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | ARNP |
| Authorized Official - Phone: | 509-773-2366 |
| Mailing Address - Street 1: | 115 S GOLDEN ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GOLDENDALE |
| Mailing Address - State: | WA |
| Mailing Address - Zip Code: | 98620-9123 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 509-773-2419 |
| Mailing Address - Fax: | 509-973-5921 |
| Practice Address - Street 1: | 115 S GOLDEN ST |
| Practice Address - Street 2: | |
| Practice Address - City: | GOLDENDALE |
| Practice Address - State: | WA |
| Practice Address - Zip Code: | 98620-9123 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 509-773-2419 |
| Practice Address - Fax: | 509-973-5921 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | KLICKITAT COUNTY |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2022-11-07 |
| Last Update Date: | 2024-02-01 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WA | BHA.FS.61358478-SUDO | Other | BEHAVIORAL HEALTH AGENCY - SUBSTANCE USE DISORDER OUTPATIENT |
| WA | BHA.FS.61358478-MHOU | Other | BEHAVIORAL HEALTH AGENCY - MENTAL HEALTH OUTPATIENT |
| WA | BHA.FS.61358478 | Other | BEHAVIORAL HEALTH AGENCY LICENSE |
