MEDICARE: CATHOLIC COMMUNITY SERVICES WW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	169	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	169	OTHER	WA	COMMUNITY MENTAL HEALTH LICENSE

General Provider Information

NPI Number	:	1568785293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC COMMUNITY SERVICES WW

Provider Business Mailing Address
First Line	:	1202 BLACK LAKE BLVD SW STE B
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-7208
Country	:	US
Telephone Number	:	360-878-8248
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 YAUGER WAY SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8660
Country	:	US
Telephone Number	:	360-878-8248
Fax Number	:

Authorized Official
Title or Position	:	SYSTEM IMPLEMENTATION SPECIALIST
Name	:	STEPHANIE MARGUERITE THELEN
Credential	:
Telephone Number	:	253-759-9544

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	01/08/2024

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