50D2190857 CLIA NUMBER - STILLAGUAMISH BEHAVIORAL HEALTH PROGRAM

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Laboratory Demographics

CLIA Number: 50D2190857

Facility Name: STILLAGUAMISH BEHAVIORAL HEALTH PROGRAM

Facility Address:
5700 172ND ST NE STE B
ARLINGTON, WA
ZIP 98223
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Facility Phone Number: 360 435-3985

Facility Type: Other - OTHER PRACTIONIER - ARNP

Certificate Type: Microscopy

NPI Number: 1225076730

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	50D2190857
LAB Type	Other - OTHER PRACTIONIER - ARNP
Facility Name	STILLAGUAMISH BEHAVIORAL HEALTH PROGRAM
Street	5700 172ND ST NE STE B
City	ARLINGTON
State	WA
ZIP	98223
Phone	360 435-3985
CertificateType	3
CertificateEffectiveDate	8/19/2020
CertificateExpirationDate	4/4/2028
FacilityType	PPMP

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This page was last updated on: 4/23/2024