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General NPI Number Information
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NPI Number | 1710287479
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Entity Type | Organization
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Legal Business Name | WESTERN STATE HOSPITAL
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 9601 STEILACOOM BLVD SW
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City | TACOMA
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State | WA
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Zip | 98498-7212
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Country | US
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Telephone | 253-756-3971
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Fax |
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Provider Business Mailing Address
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Address Line | 9601 STEILACOOM BLVD SW
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City | TACOMA
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State | WA
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Zip | 98498-7212
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Country | US
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Telephone | 253-756-3971
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC SOCIALWORKER SUPERVISOR
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Name | MS. LAUREL C. KELSO
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Credential | LICSW
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Telephone | 253-756-2966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | PY60040431
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License Number State | WA
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