Provider Demographics
NPI:1861225724
Name:OLYMPIC WELLNESS PLLC
Entity type:Organization
Organization Name:OLYMPIC WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:
Authorized Official - Last Name:DETROJA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:360-217-9425
Mailing Address - Street 1:4313 6TH AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1072
Mailing Address - Country:US
Mailing Address - Phone:360-217-9425
Mailing Address - Fax:866-522-6325
Practice Address - Street 1:4313 6TH AVE SE, SUITE C
Practice Address - Street 2:ATTN: HARRISON DETROJA
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-217-9425
Practice Address - Fax:866-522-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-24
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty