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General NPI Number Information
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NPI Number | 1629868120
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Entity Type | Organization
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Legal Business Name | THAWMINDS MENTAL HEALTH SERVICE LLC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1406 S 281ST ST
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6113
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Country | US
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Telephone | 206-353-5378
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Fax |
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Provider Business Mailing Address
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Address Line | 31140 PACIFIC HWY S
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City | FEDERAL WAY
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State | WA
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Zip | 98003-4994
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Country | US
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Telephone | 206-353-5378
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. ANTENEH ARAYA WOLDESELASSIE
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Credential | DNP-PMHNP-BC
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Telephone | 206-353-5378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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