Provider Demographics
NPI:1568785293
Name:CATHOLIC COMMUNITY SERVICES WW
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES WW
Other - Org Name:CCSWW-FPS OLYMPIA
Other - Org Type:Other Name
Authorized Official - Title/Position:SYSTEM IMPLEMENTATION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARGUERITE
Authorized Official - Last Name:THELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-759-9544
Mailing Address - Street 1:1202 BLACK LAKE BLVD SW STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-7208
Mailing Address - Country:US
Mailing Address - Phone:360-878-8248
Mailing Address - Fax:
Practice Address - Street 1:402 YAUGER WAY SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8660
Practice Address - Country:US
Practice Address - Phone:360-878-8248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA169251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA169OtherCOMMUNITY MENTAL HEALTH LICENSE