Healthcare Provider Details

I. General information

NPI: 1790372043
Provider Name (Legal Business Name): TRY CREATIVE COUNSELING SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 CENTERWOOD DR SE
OLYMPIA WA
98501-3727
US

IV. Provider business mailing address

2038 CENTERWOOD DR SE
OLYMPIA WA
98501-3727
US

V. Phone/Fax

Practice location:
  • Phone: 360-970-9878
  • Fax:
Mailing address:
  • Phone: 360-970-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. HEATHER JEANINE VAN MILL
Title or Position: COUNSELOR
Credential: L.I.C.S.W.
Phone: 360-970-9878