Healthcare Provider Details

I. General information

NPI: 1013138924
Provider Name (Legal Business Name): TULALIP TRIBES OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date: 04/10/2014
Reactivation Date: 05/09/2014

III. Provider practice location address

2821 MISSION HILL RD
TULALIP WA
98271
US

IV. Provider business mailing address

6406 MARINE DR STE A
TULALIP WA
98271
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-4400
  • Fax: 360-716-5789
Mailing address:
  • Phone: 360-651-4400
  • Fax: 360-716-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY HOWELL
Title or Position: HEALTH SYSTEM ADMINISTRATOR
Credential: DHA, FACHE
Phone: 360-716-5688