| Organization Name: | SWINOMISH TRIBAL MENTAL HEALTH PROGRAM |
| NPI Number: | 1700081775 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK BACKLUND (DIRECTOR) |
| Mailing Address: | 17395 Reservation Rd La Conner |
| State: | WA US |
| Postal Code: | 982578802 |
| Phone Number: | 3604661275 |
| Fax Number: | 3604667301 |
| NPI Enumeration Date: | 06/19/2007 |
| NPI Last Update Date: | 08/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |