Provider Demographics
NPI:1821259821
Name:UPPER SKAGIT INDIAN TRIBE
Entity Type:Organization
Organization Name:UPPER SKAGIT INDIAN TRIBE
Other - Org Name:UPPER SKAGIT TRIBAL MENTAL HEALTHCLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH & SOCIAL SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-854-7065
Mailing Address - Street 1:25944 COMMUNITY PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9721
Mailing Address - Country:US
Mailing Address - Phone:360-854-7070
Mailing Address - Fax:
Practice Address - Street 1:25959 COMMUNITY PLAZA WAY
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9721
Practice Address - Country:US
Practice Address - Phone:360-854-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPPER SKAGIT INDIAN TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008445101YM0800X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6960FEOtherREGENCE BLUE SHIELD
WA1981323Medicaid
WATEZ078Medicare PIN