Provider Demographics
NPI:1609612670
Name:NISQUALLY INDIAN TRIBE
Entity type:Organization
Organization Name:NISQUALLY INDIAN TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-456-5221
Mailing Address - Street 1:4820 SHE NAH NUM DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-9105
Mailing Address - Country:US
Mailing Address - Phone:360-456-5221
Mailing Address - Fax:
Practice Address - Street 1:10747 TODTKARLE RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-9286
Practice Address - Country:US
Practice Address - Phone:360-456-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NISQUALLY INDIAN TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty