MEDICARE: THAWMINDS MENTAL HEALTH SERVICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1629868120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THAWMINDS MENTAL HEALTH SERVICE LLC

Provider Business Mailing Address
First Line	:	26136 PACIFIC HWY S
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-6910
Country	:	US
Telephone Number	:	206-212-6189
Fax Number	:	206-429-2587

Provider Business Practice Location Address
First Line	:	26136 PACIFIC HWY S
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-6910
Country	:	US
Telephone Number	:	206-212-6189
Fax Number	:	206-429-2587

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. ANTENEH ARAYA WOLDESELASSIE
Credential	:	DNP-PMHNP-BC
Telephone Number	:	206-353-5378

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	04/01/2026

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