Healthcare Provider Details

I. General information

NPI: 1750849592
Provider Name (Legal Business Name): CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 N 44TH ST
TACOMA WA
98407-3799
US

IV. Provider business mailing address

1001 N J ST
TACOMA WA
98403-2125
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-9544
  • Fax:
Mailing address:
  • Phone: 253-761-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE M. THELEN
Title or Position: COMPLIANCE & POLICY ANALYST
Credential:
Phone: 253-761-3898