Provider Demographics
NPI:1568517563
Name:TRILLIUM TREATMENT CENTER INC.
Entity Type:Organization
Organization Name:TRILLIUM TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC, CDP
Authorized Official - Phone:360-457-9200
Mailing Address - Street 1:528 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-5810
Mailing Address - Country:US
Mailing Address - Phone:360-457-9200
Mailing Address - Fax:360-457-9229
Practice Address - Street 1:528 W 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-5810
Practice Address - Country:US
Practice Address - Phone:360-457-9200
Practice Address - Fax:360-457-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
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