Provider Demographics
NPI:1073715272
Name:SKOKOMISH INDIAN TRIBE
Entity Type:Organization
Organization Name:SKOKOMISH INDIAN TRIBE
Other - Org Name:SKOKOMISH TRIBAL MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAYLNN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-426-7788
Mailing Address - Street 1:N. 561 TRIBAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SKOKOMISH NATION
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7416
Mailing Address - Country:US
Mailing Address - Phone:360-426-7788
Mailing Address - Fax:360-462-0082
Practice Address - Street 1:N. 561 TRIBAL CENTER RD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NATION
Practice Address - State:WA
Practice Address - Zip Code:98584-7416
Practice Address - Country:US
Practice Address - Phone:360-426-7788
Practice Address - Fax:360-462-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010657101YM0800X
WALH00009495101YM0800X
WAPY00002366103T00000X
WAMD00012725207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1980796Medicaid