Provider Demographics
NPI:1376644146
Name:HIGHLAND COURTE ALZHEIMER
Entity Type:Organization
Organization Name:HIGHLAND COURTE ALZHEIMER
Other - Org Name:HIGHLAND COURTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVICH-GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:360-417-5356
Mailing Address - Street 1:1704 MELODY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-417-5356
Mailing Address - Fax:360-417-2773
Practice Address - Street 1:1704 MELODY CIRCLE
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-417-5356
Practice Address - Fax:360-417-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty