Organization
QUILEUTE COUNSELING AND RECOVERY SUBSTANCE USE DISORDER
Active
Parent organization
QUILEUTE TRIBAL COUNCIL
Other names
Quileute Counseling and Recovery Substance Use Disorder
Organization subpart
Yes
Provider details
NPI number
Legal business name
QUILEUTE TRIBAL COUNCIL
Authorized official
GARY BRYAN GOODWIN (BILLING AGENCY)
(360) 867-0709
Entity
Organization
Contact information
Practice address
560 QUILEUTE HEIGHTS LOOP, LA PUSH, WA 98350
(360) 374-3358
Mailing address
PO BOX 189, LA PUSH, WA 98350-0189
(360) 374-3358
(360) 374-2644
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/08/2019
Last updated
03/08/2019
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