| Organization Name: | NOOKSACK TRIBES GENESIS II |
| NPI Number: | 1699975466 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM W. WOOLSEY (TREATMENT DIRECTOR) |
| Mailing Address: | 6750 Mission Rd Everson |
| State: | WA US |
| Postal Code: | 982479749 |
| Phone Number: | 3609667704 |
| Fax Number: | 3609664225 |
| NPI Enumeration Date: | 07/20/2007 |
| NPI Last Update Date: | 07/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 020300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |