Provider Demographics
NPI:1639056146
Name:SELF HEALS THERAPY, PLLC
Entity type:Organization
Organization Name:SELF HEALS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-228-5757
Mailing Address - Street 1:PO BOX 11183
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1183
Mailing Address - Country:US
Mailing Address - Phone:503-440-7378
Mailing Address - Fax:
Practice Address - Street 1:3721 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2645
Practice Address - Country:US
Practice Address - Phone:503-440-7378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty