Healthcare Provider Details

I. General information

NPI: 1073423042
Provider Name (Legal Business Name): SELINA NICOLE WHITESIDES RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 S FIDDLERS GREEN CIR STE 300E
GREENWOOD VILLAGE CO
80111-4831
US

IV. Provider business mailing address

12275 CLAUDE CT
NORTHGLENN CO
80241-3353
US

V. Phone/Fax

Practice location:
  • Phone: 385-406-2590
  • Fax: 385-494-3503
Mailing address:
  • Phone: 702-445-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: