Provider Demographics
NPI:1669826533
Name:MUCKLESHOOT BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MUCKLESHOOT BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN- SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:253-939-6648
Mailing Address - Street 1:17813 SE 392ND ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-9126
Mailing Address - Country:US
Mailing Address - Phone:253-804-8752
Mailing Address - Fax:253-333-3628
Practice Address - Street 1:17813 SE 392ND ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-9126
Practice Address - Country:US
Practice Address - Phone:253-804-8752
Practice Address - Fax:253-333-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60099083251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health