Healthcare Provider Details

I. General information

NPI: 1497571251
Provider Name (Legal Business Name): AVERY ELYSE SELCH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 DOGWOOD LN
CARMEL IN
46032-9629
US

IV. Provider business mailing address

PO BOX 523882 C/O THE MAILBOX #10649
MIAMI FL
33152
US

V. Phone/Fax

Practice location:
  • Phone: 317-498-1171
  • Fax: 317-219-0879
Mailing address:
  • Phone: 317-498-1171
  • Fax: 317-219-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71016083A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71016083A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: