MEDICARE: MIND AND HEART COUNSELING, 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	1041C0700X	Clinical Social Worker
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1891524856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND AND HEART COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	855 TROSPER RD SW # 108-255
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98512-8108
Country	:	US
Telephone Number	:	360-451-6497
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 COOPER POINT RD SW STE A1
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-1109
Country	:	US
Telephone Number	:	360-451-6497
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA BRYDEN
Credential	:	LICSW
Telephone Number	:	970-568-6085

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	12/15/2025

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