Provider Demographics
NPI:1790180214
Name:CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON
Other - Org Name:CREW
Other - Org Type:Other Name
Authorized Official - Title/Position:COMPLIANCE & POLICY ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:THELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-761-3898
Mailing Address - Street 1:1902 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1155
Mailing Address - Country:US
Mailing Address - Phone:206-956-9570
Mailing Address - Fax:
Practice Address - Street 1:1902 2ND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1155
Practice Address - Country:US
Practice Address - Phone:206-956-9572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA081251S00000X
261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABHA.FS.60873344OtherDOH BHA LICENSE
WA17 0343 00OtherSTATE OF WASHINGTON CHEMICAL DEPENDENCY PROVIDER LICENSE