Provider Demographics
NPI:1487472700
Name:USSELMAN, MEAGAN (QMHA-R)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:USSELMAN
Suffix:
Gender:F
Credentials:QMHA-R
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 21842
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97307-1842
Mailing Address - Country:US
Mailing Address - Phone:503-577-7753
Mailing Address - Fax:503-616-3804
Practice Address - Street 1:780 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 202 & 305
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3463
Practice Address - Country:US
Practice Address - Phone:503-577-7753
Practice Address - Fax:503-616-3804
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health