Healthcare Provider Details

I. General information

NPI: 1518183763
Provider Name (Legal Business Name): WEST SOUND TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 LUMSDEN RD
PORT ORCHARD WA
98367-9179
US

IV. Provider business mailing address

1415 LUMSDEN RD
PORT ORCHARD WA
98367-9179
US

V. Phone/Fax

Practice location:
  • Phone: 360-876-9430
  • Fax: 360-876-0713
Mailing address:
  • Phone: 360-876-9430
  • Fax: 360-876-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name: MS. CHERIE E. DURHAM
Title or Position: EXECUTIVE ASSISTANT
Credential: AA
Phone: 360-876-9430