Provider Demographics
NPI:1013138924
Name:TULALIP TRIBES OF WASHINGTON
Entity Type:Organization
Organization Name:TULALIP TRIBES OF WASHINGTON
Other - Org Name:TULALIP TRIBES FAMILY SERVICES - ADULT MENTAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH SYSTEM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DHA, FACHE
Authorized Official - Phone:360-716-5688
Mailing Address - Street 1:6406 MARINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271
Mailing Address - Country:US
Mailing Address - Phone:360-651-4400
Mailing Address - Fax:360-716-5789
Practice Address - Street 1:2821 MISSION HILL RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271
Practice Address - Country:US
Practice Address - Phone:360-716-4400
Practice Address - Fax:360-716-5789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2024-05-08
Deactivation Date:2014-04-10
Deactivation Code:
Reactivation Date:2014-05-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036113Medicaid