Provider Demographics
NPI: | 1639601719 |
---|---|
Name: | ESD 113 SOUND TO HARBOR HEAD START/ECEAP |
Entity Type: | Organization |
Organization Name: | ESD 113 SOUND TO HARBOR HEAD START/ECEAP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ASSISTANT SUPERINTENDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MATTHEW |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SOLOMON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 360-464-6800 |
Mailing Address - Street 1: | 6005 TYEE DR SW |
Mailing Address - Street 2: | |
Mailing Address - City: | TUMWATER |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98512-7356 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 360-464-6800 |
Mailing Address - Fax: | 360-464-6903 |
Practice Address - Street 1: | 6005 TYEE DR SW |
Practice Address - Street 2: | |
Practice Address - City: | TUMWATER |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98512-7356 |
Practice Address - Country: | US |
Practice Address - Phone: | 360-464-6800 |
Practice Address - Fax: | 360-464-6903 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-03-29 |
Last Update Date: | 2017-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |