Provider Demographics
NPI:1518183763
Name:WEST SOUND TREATMENT CENTER
Entity Type:Organization
Organization Name:WEST SOUND TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:AA
Authorized Official - Phone:360-876-9430
Mailing Address - Street 1:1415 LUMSDEN RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9179
Mailing Address - Country:US
Mailing Address - Phone:360-876-9430
Mailing Address - Fax:360-876-0713
Practice Address - Street 1:1415 LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9179
Practice Address - Country:US
Practice Address - Phone:360-876-9430
Practice Address - Fax:360-876-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
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 - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1993500Medicaid