Healthcare Provider Details

I. General information

NPI: 1952505224
Provider Name (Legal Business Name): MARGO JEAN SELLERS MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W AVENUE J SUITE C
LANCASTER CA
93534-3443
US

IV. Provider business mailing address

3144 GOLFWOOD CT
LANCASTER CA
93536-1114
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-0131
  • Fax:
Mailing address:
  • Phone: 818-919-0473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: