Provider Demographics
NPI:1235795493
Name:NORTH CASCADE RECOVERY
Entity Type:Organization
Organization Name:NORTH CASCADE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:
Authorized Official - First Name:KELSY
Authorized Official - Middle Name:
Authorized Official - Last Name:OZUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-707-4650
Mailing Address - Street 1:1558 PORTO BELLO AVE
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-7428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 S 2ND ST STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3814
Practice Address - Country:US
Practice Address - Phone:360-707-4650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty