Healthcare Provider Details

I. General information

NPI: 1699697664
Provider Name (Legal Business Name): ADAPTIVE CHANGE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 ENSIGN RD NE STE A
OLYMPIA WA
98506-6104
US

IV. Provider business mailing address

3627 ENSIGN RD NE STE A
OLYMPIA WA
98506-6104
US

V. Phone/Fax

Practice location:
  • Phone: 360-259-5966
  • Fax: 360-628-8928
Mailing address:
  • Phone: 360-259-5966
  • Fax: 360-628-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. HARRI ANN DONNA ELLIS
Title or Position: CLINICIAN/OWNER
Credential: ELLIS
Phone: 360-259-5966