Provider Demographics
NPI:1649923624
Name:TOLIVER, MEGAN LAURA (LICSW, NCAC II)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LAURA
Last Name:TOLIVER
Suffix:
Gender:F
Credentials:LICSW, NCAC II
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MCGAVOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 W ROSE ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1662
Mailing Address - Country:US
Mailing Address - Phone:509-525-6650
Mailing Address - Fax:509-522-2349
Practice Address - Street 1:1120 W ROSE ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1662
Practice Address - Country:US
Practice Address - Phone:509-525-6650
Practice Address - Fax:509-522-2349
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610649671041C0700X
WALW610649671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical