Provider Demographics
NPI:1215562541
Name:SELEVCHUK, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:SELEVCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17701 108TH AVE SE # 336
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6448
Mailing Address - Country:US
Mailing Address - Phone:425-430-8229
Mailing Address - Fax:425-336-2785
Practice Address - Street 1:13470 MARTIN LUTHER KING JR WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-5210
Practice Address - Country:US
Practice Address - Phone:425-430-8229
Practice Address - Fax:425-336-2785
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61045771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health