MEDICARE: TAPESTRY MENTAL HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1275489494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAPESTRY MENTAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	4405 7TH AVE SE STE 200
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1055
Country	:	US
Telephone Number	:	360-997-0103
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 7TH AVE SE SUITE 200 #1146
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1055
Country	:	US
Telephone Number	:	360-997-0103
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAMELA JACKSON
Credential	:	PHD, PMHNP-BC
Telephone Number	:	360-997-0103

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	05/03/2026

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