Basic Information
| Provider Information | |||||||||
| NPI: | 1326238379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SELVIG | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | LAUREEN | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 PETERSON STREET | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079668623 | ||||||||
| FaxNumber: | 9079668627 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 TONGASS | ||||||||
| Address2: | 1209 | ||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079668621 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.