| Providence Health & Service Washington | |
|
218-a Main Street Morton WA 98356-0000 | |
| (360) 496-6216 | |
| (360) 496-6232 |
| Full Name | Providence Health & Service Washington |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 218-a Main Street, Morton, Washington |
| Authorized Official Name and Position | Nicole Quinn (PAYOR CREDENTIALING MANAGER) |
| Authorized Official Contact | 4255256715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health & Service Washington Po Box 34439 Seattle WA 98124-1439 Ph: (425) 525-6778 | Providence Health & Service Washington 218-a Main Street Morton WA 98356-0000 Ph: (360) 496-6216 |
| NPI Number | 1104024348 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104024348 | NPI | - | NPPES |
| 602 399 531 | Other | WA | UBI MASTER LICENSE |
| 1250 | Other | WA | BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |