MEDICARE: CREATIVE RELATIONAL THERAPY PLLC

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1952262321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE RELATIONAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	5424 S PUGET SOUND AVE STE 14
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-4311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5424 S PUGET SOUND AVE STE 14
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-4311
Country	:	US
Telephone Number	:	253-220-7749
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	NATHALIE HERRIDGE
Credential	:	LMFT
Telephone Number	:	253-220-7749

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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