Provider Demographics
NPI:1588622823
Name:CASCADE MENTAL HEALTH PS
Entity type:Organization
Organization Name:CASCADE MENTAL HEALTH PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:LAGDAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-475-7333
Mailing Address - Street 1:3711 PACIFIC AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7800
Mailing Address - Country:US
Mailing Address - Phone:253-475-7333
Mailing Address - Fax:253-475-7336
Practice Address - Street 1:3711 PACIFIC AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7800
Practice Address - Country:US
Practice Address - Phone:253-475-7333
Practice Address - Fax:253-475-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9648676Medicaid
WA9648676Medicaid