Provider Demographics
NPI:1194558478
Name:TULALIP TRIBES OF WASHINGTON
Entity type:Organization
Organization Name:TULALIP TRIBES OF WASHINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & PRIVILEGING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-716-5696
Mailing Address - Street 1:6406 MARINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-9775
Mailing Address - Country:US
Mailing Address - Phone:360-716-4400
Mailing Address - Fax:425-259-8626
Practice Address - Street 1:2821 MISSION HILL RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9706
Practice Address - Country:US
Practice Address - Phone:360-716-4400
Practice Address - Fax:425-259-8626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULALIP TRIBES OF WASHINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-22
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty