Provider Demographics
NPI:1952597056
Name:COMPREHENSIVE MENTAL HEALTH CENTER OF TACOMA-PIERCE COUNTY
Entity Type:Organization
Organization Name:COMPREHENSIVE MENTAL HEALTH CENTER OF TACOMA-PIERCE COUNTY
Other - Org Name:COMPREHENSIVE LIFE RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-396-5800
Mailing Address - Street 1:737 FAWCETT AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5503
Mailing Address - Country:US
Mailing Address - Phone:253-396-5800
Mailing Address - Fax:253-396-5825
Practice Address - Street 1:737 FAWCETT AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5503
Practice Address - Country:US
Practice Address - Phone:253-396-5800
Practice Address - Fax:253-396-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA053251B00000X, 251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1984103Medicaid