Healthcare Provider Details

I. General information

NPI: 1063502946
Provider Name (Legal Business Name): TULALIP TRIBES OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

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: 360-716-4400
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number31-0240-00
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MIKU SODHI
Title or Position: MANAGING DIRECTOR OF HEALTH SERVICE
Credential:
Phone: 360-716-4511