Provider Demographics
NPI:1639354194
Name:STILLAGUAMISH TRIBE OF INDIANS
Entity Type:Organization
Organization Name:STILLAGUAMISH TRIBE OF INDIANS
Other - Org Name:MENTAL HEALTH PROGRAMS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:360-653-1104
Mailing Address - Street 1:4126 172ND ST NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6384
Mailing Address - Country:US
Mailing Address - Phone:360-653-1104
Mailing Address - Fax:360-653-3277
Practice Address - Street 1:4126 172ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6384
Practice Address - Country:US
Practice Address - Phone:360-653-1104
Practice Address - Fax:360-653-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health