Basic Information
Provider Information
NPI: 1861872178
EntityType: 2
ReplacementNPI:  
OrganizationName: MULTICARE HEALTH SYSTEM
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: MULTICARE BEHAVIORAL HEALTH
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
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Mailing Information
Address1: 202 N DIVISION ST STE 200
Address2:  
City: AUBURN
State: WA
PostalCode: 980014939
CountryCode: US
TelephoneNumber: 2536978400
FaxNumber:  
Practice Location
Address1: 202 N DIVISION ST STE 200
Address2:  
City: AUBURN
State: WA
PostalCode: 980014939
CountryCode: US
TelephoneNumber: 2536978400
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/02/2015
LastUpdateDate: 08/31/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: VANDERBUSH
AuthorizedOfficialFirstName: LORI
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: RECRUITING ASSOCIATE
AuthorizedOfficialTelephone: 2534037726
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselor 
101YA0400X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
101YM0800X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorMental Health
101YP2500X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorProfessional
103T00000X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologist 
103TA0400X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
103TC0700X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologistClinical
103TC1900X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologistCounseling
103TH0004X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologistHealth
103TH0100X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologistHealth Service
103TP2701X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
104100000X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersSocial Worker 
1041C0700X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersSocial WorkerClinical
106H00000X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersMarriage & Family Therapist 
251S00000X51WAY AgenciesCommunity/Behavioral Health 

No ID Information.


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