Provider Demographics
NPI:1225076730
Name:STILLAGUAMISH TRIBE OF INDIANS
Entity Type:Organization
Organization Name:STILLAGUAMISH TRIBE OF INDIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SOCIAL & HEALTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-653-1104
Mailing Address - Street 1:4126 172ND ST NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6384
Mailing Address - Country:US
Mailing Address - Phone:360-653-1104
Mailing Address - Fax:360-657-2884
Practice Address - Street 1:4126 172ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6384
Practice Address - Country:US
Practice Address - Phone:360-653-1104
Practice Address - Fax:360-657-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QM0850X, 261QM0855X
WA31113900261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Not Answered261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone