Provider Demographics
NPI:1124766936
Name:SELVIG, TAMARA (LPC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SELVIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:
Other - Last Name:SELVIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:SELVIG COUNSELING SERVICES
Mailing Address - Street 2:4160 24TH AVE S, SUITE 102
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-941-0175
Mailing Address - Fax:
Practice Address - Street 1:SELVIG COUNSELING SERVICES
Practice Address - Street 2:4160 24TH AVE S, SUITE 102
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-941-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional