Healthcare Provider Details

I. General information

NPI: 1841089919
Provider Name (Legal Business Name): CEDAR & SAGE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SLEATER KINNEY RD SE
LACEY WA
98503-2316
US

IV. Provider business mailing address

1210 SLEATER KINNEY RD SE
LACEY WA
98503-2316
US

V. Phone/Fax

Practice location:
  • Phone: 253-242-3560
  • Fax:
Mailing address:
  • Phone: 253-242-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KEANNA SMITH
Title or Position: OWNER
Credential: PMHNP-BC, ARNP
Phone: 253-242-3560