Provider Demographics
NPI:1053927707
Name:MOELLER, MEGAN BRIANA (LMHCA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BRIANA
Last Name:MOELLER
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7314
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-0941
Mailing Address - Country:US
Mailing Address - Phone:253-880-4871
Mailing Address - Fax:
Practice Address - Street 1:417 E PIONEER STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3267
Practice Address - Country:US
Practice Address - Phone:253-880-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61086328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health