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PROVIDENCE HEALTH & SERVICE WASHINGTON NPI 1124226360


NPI Information

NPI: 1124226360
Provider Name: PROVIDENCE HEALTH & SERVICE WASHINGTON

Doing Business As: PROVIDENCE ADDICTIONS RECOVERY CTR

Classification: Psychologist - 103TA0400X
Entity Type: Organization

Specialization: Addiction (Substance Use Disorder)

Address:
1800 COOKS HILL RD
SUITE G
CENTRALIA, WA
ZIP 98531
Phone: (360) 827-8200
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PROVIDENCE HEALTH & SERVICE WASHINGTON is an addiction (substance use disorder) psychologist in Centralia, WA. The provider is a psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior. PROVIDENCE HEALTH & SERVICE WASHINGTON NPI is 1124226360. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Addictions Recovery Ctr.

The provider's business location address is:

1800 COOKS HILL RD
SUITE G
CENTRALIA, WA
ZIP 98531-072
Phone: (360) 827-8200
Fax: (360) 827-8367

The provider's authorized official is Nicole Quinn .
The authorized official title is Payor Credentialing Manager and has the following contact phone number (425) 525-6715.

The enumeration date for this NPI number is 7/10/2007 and was last updated on 12/22/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TA0400XPsychologistAddiction (Substance Use Disorder)WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
121 0354 00MEDICAIDWASHINGTONCERT OF APPROVAL CHEM DEP
215835OTHERWASHINGTONCITY OF CHEHALIS BUSINESS
3602 399 531OTHERWASHINGTONUBI MASTER LICENSE
4G8802110MEDICARE PINWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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