Provider Demographics
NPI:1356830467
Name:SELVAGE, MEGAN SIERRA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:SIERRA
Last Name:SELVAGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 2ND ST SW UNIT 453
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5546
Mailing Address - Country:US
Mailing Address - Phone:253-337-3696
Mailing Address - Fax:
Practice Address - Street 1:3306 E MIDDLE RD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3239
Practice Address - Country:US
Practice Address - Phone:253-337-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA60907149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health