Healthcare Provider Details

I. General information

NPI: 1184159816
Provider Name (Legal Business Name): NEW PHOEBE HOUSE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 YAKIMA AVE STE 14
TACOMA WA
98405-4869
US

IV. Provider business mailing address

712 MARTIN LUTHER KING JR WAY PO BOX 5245
TACOMA WA
98405-4138
US

V. Phone/Fax

Practice location:
  • Phone: 253-267-5402
  • Fax: 253-328-7301
Mailing address:
  • Phone: 253-383-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: RENA KAY THOMPSON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 253-433-2321