Provider Demographics
NPI:1770910861
Name:HARTSSPACE MENTAL HEALTH AND NUTRITION COUNSELING
Entity type:Organization
Organization Name:HARTSSPACE MENTAL HEALTH AND NUTRITION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MENTAL HEALTH AND NUTRITION
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CN, LMHC
Authorized Official - Phone:360-915-2151
Mailing Address - Street 1:2116 CATON WAY SW STE 102
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1176
Mailing Address - Country:US
Mailing Address - Phone:360-915-2151
Mailing Address - Fax:360-754-2145
Practice Address - Street 1:2116 CATON WAY SW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1176
Practice Address - Country:US
Practice Address - Phone:360-915-2151
Practice Address - Fax:360-754-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60040674133N00000X
WANU60334795133N00000X
WALH 60138935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty