Provider Demographics
NPI:1275017014
Name:VICTORIAN, SIARA (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:SIARA
Middle Name:
Last Name:VICTORIAN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16128 81ST AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6876
Mailing Address - Country:US
Mailing Address - Phone:253-988-3811
Mailing Address - Fax:
Practice Address - Street 1:12511 MERIDIAN E STE 201
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3425
Practice Address - Country:US
Practice Address - Phone:253-881-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist