Healthcare Provider Details

I. General information

NPI: 1558593350
Provider Name (Legal Business Name): CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR SUITE B
VANCOUVER WA
98662-6347
US

IV. Provider business mailing address

9300 NE OAK VIEW DR SUITE B
VANCOUVER WA
98662-6347
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax: 360-567-2212
Mailing address:
  • Phone: 360-567-2211
  • Fax: 360-567-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number192
License Number StateWA

VIII. Authorized Official

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