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General NPI Number Information
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NPI Number | 1639056146
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Entity Type | Organization
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Legal Business Name | SELF HEALS THERAPY, PLLC
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 3721 4TH AVE NW
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City | OLYMPIA
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State | WA
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Zip | 98502-2645
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Country | US
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Telephone | 503-440-7378
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11183
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City | OLYMPIA
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State | WA
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Zip | 98508-1183
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Country | US
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Telephone | 503-440-7378
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Fax |
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Authorized Official
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Title or Position | CREDENTIALER/BILLER
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Name | DANIELA BONELLO
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Credential |
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Telephone | 253-228-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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