Provider Demographics
NPI:1790826600
Name:STILLAGUAMISH TRIBE OF INDIANS
Entity Type:Organization
Organization Name:STILLAGUAMISH TRIBE OF INDIANS
Other - Org Name:ISLAND CROSSING COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREATMENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-652-9640
Mailing Address - Street 1:21123 SMOKEY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4224
Mailing Address - Country:US
Mailing Address - Phone:360-652-9640
Mailing Address - Fax:360-652-2093
Practice Address - Street 1:21123 SMOKEY POINT BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-4224
Practice Address - Country:US
Practice Address - Phone:360-652-9640
Practice Address - Fax:360-652-2093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STILLAGUAMISH TRIBE OF INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1994565Medicaid