Healthcare Provider Details

I. General information

NPI: 1821901216
Provider Name (Legal Business Name): THE FORGE AND THE VINE COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 S 67TH AVE
YAKIMA WA
98903-9497
US

IV. Provider business mailing address

2133 S 67TH AVE
YAKIMA WA
98903-9497
US

V. Phone/Fax

Practice location:
  • Phone: 509-356-6688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NATHAN LEE THOMPSON
Title or Position: OWNER/COUNSELOR
Credential: MA, LMHCA
Phone: 509-356-6688