Healthcare Provider Details

I. General information

NPI: 1417721473
Provider Name (Legal Business Name): FREESIA THERAPY COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 213TH AVENUE CT E
LAKE TAPPS WA
98391-6134
US

IV. Provider business mailing address

6226 213TH AVENUE CT E
LAKE TAPPS WA
98391-6134
US

V. Phone/Fax

Practice location:
  • Phone: 253-455-0931
  • Fax:
Mailing address:
  • Phone: 253-455-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN J LINDSEY
Title or Position: MANAGER/PARTNER
Credential: LICSW
Phone: 253-455-0931