Haeman Song, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00006142 Issued in WA

Practice address

560 Quileute Heights
Lapush, WA 98350

Phone

(360) 374-6076

Fax

(360) 374-5014

NPI assigned

Aug 28, 2007

Last updated

Aug 28, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Quileute Tribal Council

  • Clinic/Center
  • La Push, WA
  • NPI 1548329105
  NPD (past)

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188259200000",
    "number": "1861686461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "LA PUSH",
            "state": "WA",
            "postal_code": "983500279",
            "telephone_number": "360-374-6076",
            "fax_number": "360-374-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 QUILEUTE HEIGHTS",
            "city": "LAPUSH",
            "state": "WA",
            "postal_code": "98350",
            "telephone_number": "360-374-6076",
            "fax_number": "360-374-5014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "HAEMAN",
        "credential": "CDP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-28",
        "last_updated": "2007-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00006142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7084486",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Marie Neel, REGISTERED NURSE
• Quileute Counseling and Recovery Mental Health
• Quileute Tribal Council (Quileute Dental Clinic)
• Quileute Tribal Council
• Quileute Tribal Council
• Kaela Renee Tyler

• Addiction (Substance Use Disorder) Counselor in La Push, WA
• Providers in La Push, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.