Basic Information
| Provider Information | |||||||||
| NPI: | 1528472370 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIMPLY THRIVE PSYCHOTHERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 CARPENTER RD SE STE 203 | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985037905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608789526 | ||||||||
| FaxNumber: | 8882238248 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 CARPENTER RD SE STE 203 | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985037905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608789526 | ||||||||
| FaxNumber: | 8882238248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2014 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | SEYMANSKI | ||||||||
| AuthorizedOfficialFirstName: | NICHOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DOCTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3608789526 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D | ||||||||
| NPICertificationDate: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 163WP0809X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.