Provider Demographics
NPI:1396232435
Name:DEGALLIER, MEGHAN (MSW, MHP, LICSWA)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:DEGALLIER
Suffix:
Gender:F
Credentials:MSW, MHP, LICSWA
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:NOELLE DEGALLIER
Other - Last Name:AVERETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-1118
Mailing Address - Country:US
Mailing Address - Phone:360-423-2806
Mailing Address - Fax:
Practice Address - Street 1:404 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-1118
Practice Address - Country:US
Practice Address - Phone:360-423-2806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60672668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health