Healthcare Provider Details

I. General information

NPI: 1518019272
Provider Name (Legal Business Name): KALISPEL TRIBE-CAMAS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S GARFIELD RD
AIRWAY HEIGHTS WA
99001-9030
US

IV. Provider business mailing address

934 S GARFIELD RD
AIRWAY HEIGHTS WA
99001-9030
US

V. Phone/Fax

Practice location:
  • Phone: 509-789-7630
  • Fax: 509-343-4128
Mailing address:
  • Phone: 509-789-7630
  • Fax: 509-343-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number32117400
License Number StateWA

VIII. Authorized Official

Name: MRS. ANNETTE HALL
Title or Position: BEHAVIORAL HEALTH ADMINISTRATOR
Credential: MSW, LICSW, SUDP, NC
Phone: 509-447-7430