Healthcare Provider Details

I. General information

NPI: 1528472370
Provider Name (Legal Business Name): SIMPLY THRIVE PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CARPENTER RD SE STE 203
LACEY WA
98503-7905
US

IV. Provider business mailing address

418 CARPENTER RD SE STE 203
LACEY WA
98503-7905
US

V. Phone/Fax

Practice location:
  • Phone: 360-878-9526
  • Fax: 888-223-8248
Mailing address:
  • Phone: 360-878-9526
  • Fax: 888-223-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLE SEYMANSKI
Title or Position: DOCTOR/OWNER
Credential: PSY.D
Phone: 360-878-9526