Basic Information
| Provider Information | |||||||||
| NPI: | 1750849592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 N J ST | ||||||||
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| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984032125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537613898 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5410 N 44TH ST | ||||||||
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| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984073799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537599544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2019 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | THELEN | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | COMPLIANCE & POLICY ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 2537613898 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.