Provider Demographics
NPI:1396056461
Name:SKOKOMISH TRIBAL COUNCIL
Entity type:Organization
Organization Name:SKOKOMISH TRIBAL COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGSHORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-426-5755
Mailing Address - Street 1:561 N TRIBAL CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SKOKOMISH NATION
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9748
Mailing Address - Country:US
Mailing Address - Phone:360-426-5755
Mailing Address - Fax:360-402-0082
Practice Address - Street 1:561 N TRIBAL CENTER RD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NATION
Practice Address - State:WA
Practice Address - Zip Code:98584-7416
Practice Address - Country:US
Practice Address - Phone:360-426-5755
Practice Address - Fax:360-402-0082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKOKOMISH TRIBAL COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1042775Medicaid