Healthcare Provider Details

I. General information

NPI: 1366634552
Provider Name (Legal Business Name): CONFEDERATED TRIBES AND BANDS OF THE YAKAMA NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SIGNAL PEAK ROAD
WHITE SWAN WA
98952
US

IV. Provider business mailing address

401 FORT ROAD
TOPPENISH WA
98948
US

V. Phone/Fax

Practice location:
  • Phone: 509-874-2979
  • Fax: 509-874-2113
Mailing address:
  • Phone: 509-865-5121
  • Fax: 509-874-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: ELLEN M SWAN
Title or Position: PROGRAM MANAGER
Credential:
Phone: 509-874-2979