Organization
NORTHWEST INDIAN TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUNE O'BRIEN (DIRECTOR)
(360) 470-1474
Entity
Organization
Contact information
Practice address
100 SE WHITENER RD, SHELTON, WA 98584-7747
(360) 470-1474
Mailing address
308 E. YOUNG ST., BOX 477, ELMA, WA 98541
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
23037400
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1981026
—
WA
Enumeration date
02/26/2007
Last updated
08/22/2020
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