Healthcare Provider Details

I. General information

NPI: 1073715272
Provider Name (Legal Business Name): SKOKOMISH INDIAN TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N. 561 TRIBAL CENTER RD
SKOKOMISH NATION WA
98584-7416
US

IV. Provider business mailing address

N. 561 TRIBAL CENTER RD
SKOKOMISH NATION WA
98584-7416
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-7788
  • Fax: 360-462-0082
Mailing address:
  • Phone: 360-426-7788
  • Fax: 360-462-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00010657
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00002366
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberMD00012725
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00009495
License Number StateWA

VIII. Authorized Official

Name: MAYLNN FOSTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-426-7788