Olympia Mental Health and Psychiatry PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

OLYMPIA MENTAL HEALTH AND PSYCHIATRY PLLC

Practice address

4405 7TH Ave SE, Ste 200 - BMP 1133
Lacey, WA 98503-9850

Phone

(360) 447-8477

Fax

(360) 783-4475

NPI assigned

Aug 17, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shanti Herzog, ARNPNPI 1770959025

Title

Owner

Phone

(360) 447-8477

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shanti Elizabeth Herzog, FNP

  • Family Nurse Practitioner
  • Tumwater, WA
  • NPI 1770959025
  NPD Authorized official
• Daniel Saul Fajans

  • Mental Health Counselor
  • Olympia, WA
  • NPI 1093223620
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732924800000",
    "number": "1164198628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 7TH AVE SE, STE 200 - BMP 1133",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031055",
            "telephone_number": "360-447-8477",
            "fax_number": "360-783-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 7TH AVE SE, STE 200 - BMP 1133",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985039850",
            "telephone_number": "360-447-8477",
            "fax_number": "360-783-4475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIA MENTAL HEALTH AND PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2024-11-30",
        "certification_date": "2024-11-30",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "SHANTI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-447-8477",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Oldfield
• Serina Olivares, LMSW
• Valerie Olney, LMP
• Thomas Donald Olson
• Olympia Dental Group
• Olympia Open MRI LLC
• Olympia Orthopaedic Associates, PLLC
• Olympia Physical Therapy & Industrial Rehabilitation, Inc.
• Olympia Smiles Dentistry for All Ages
• Olympic Counseling Group

• Mental Health Clinic/Center (Including Community Mental Health Center) in Lacey, WA
• Providers in Lacey, WA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.