=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851295315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINTERBERRY PSYCHOTHERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2026
-----------------------------------------------------
Last Update Date | 10/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1930 S SHERIDAN AVE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98405-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-722-6350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 N HOWARD ST STE R
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99201-0508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-722-6350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND SOLE MEMBER
-----------------------------------------------------
Name | AUDREY OLIVER
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 253-722-6350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------