NPIMap

Organization Active NPI

Tulalip Tribes of Washington

Doing business as Tulalip Tribes Family & Youth Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Tulalip, WA
National Provider Identifier
1063502946
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
TULALIP TRIBES OF WASHINGTON
Doing business as
Tulalip Tribes Family & Youth Services
Practice address
2821 Mission Hill Rd
Tulalip, WA 98271
Phone
(360) 716-4400
Fax
(360) 716-5789
NPI assigned
Oct 13, 2006
Last updated
Nov 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Miku Sodhi
Title
Managing Director of Health Service
Phone
(360) 716-4511

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X 31-0240-00 WA
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

2821 Mission Hill Rd
Tulalip, WA 98271

Mailing address

6406 Marine Dr Ste a
Tulalip, WA 98271
Phone (360) 716-4400

Other identifiers 4

IdentifierTypeStateIssuer
1980952MedicaidWA
198754MedicaidWA
1001570MedicaidWA
1993476MedicaidWA

Other names 1

  • Tulalip Tribes Family & Youth Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160615001117 TX Part B Supplier - Clinic/Group Practice 7719879782 Receives reassigned benefits from 49 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tulalip, WA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Tulalip Tribes Health Clinic13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6406 Marine Dr
Ste A
Tulalip, WA 98271

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1063502946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6406 MARINE DR STE A",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "98271",
            "telephone_number": "360-716-4400",
            "fax_number": "360-716-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 MISSION HILL RD",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "98271",
            "telephone_number": "360-716-4400",
            "fax_number": "360-716-5789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULALIP TRIBES OF WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "SODHI",
        "authorized_official_first_name": "MIKU",
        "authorized_official_title_or_position": "MANAGING DIRECTOR OF HEALTH SERVICE",
        "authorized_official_telephone_number": "360-716-4511",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WA",
            "license": "31-0240-00",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1980952",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "198754",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001570",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1993476",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tulalip Tribes Family & Youth Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulalip, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.