Healthcare Provider Details

I. General information

NPI: 1699356683
Provider Name (Legal Business Name): TULALIP TRIBES OF WASHINGTON QUIL CEDA CREEK COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 31ST AVE NE STE 101
TULALIP WA
98271-7423
US

IV. Provider business mailing address

6330 31ST AVE NE STE 101
TULALIP WA
98271-7423
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-2200
  • Fax:
Mailing address:
  • Phone: 360-716-2200
  • Fax: 360-716-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: TANYA BURNS
Title or Position: ADMINISTRATOR
Credential:
Phone: 360-716-2200