MEDICARE: SIMPLY THRIVE PSYCHOTHERAPY PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	101YM0800X	Mental Health Counselor
3	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse
4	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1528472370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY THRIVE PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	418 CARPENTER RD SE STE 203
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-7905
Country	:	US
Telephone Number	:	360-878-9526
Fax Number	:	888-223-8248

Provider Business Practice Location Address
First Line	:	418 CARPENTER RD SE STE 203
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-7905
Country	:	US
Telephone Number	:	360-878-9526
Fax Number	:	888-223-8248

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. NICHOLE SEYMANSKI
Credential	:	PSY.D
Telephone Number	:	360-878-9526

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	01/21/2020

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