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General NPI Number Information
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NPI Number | 1669826533
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Entity Type | Organization
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Legal Business Name | MUCKLESHOOT BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 17813 SE 392ND ST
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City | AUBURN
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State | WA
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Zip | 98092-9126
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Country | US
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Telephone | 253-804-8752
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Fax | 253-333-3628
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Provider Business Mailing Address
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Address Line | 17813 SE 392ND ST
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City | AUBURN
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State | WA
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Zip | 98092-9126
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Country | US
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Telephone | 253-804-8752
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Fax | 253-333-3628
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Authorized Official
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Title or Position | HEALTH MANAGER
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Name | KAT GOODWIN- SNYDER
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Credential | CAC
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Telephone | 253-939-6648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CP60099083
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License Number State | WA
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