Healthcare Provider Details

I. General information

NPI: 1841881257
Provider Name (Legal Business Name): SELENA KEJBOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 TELEGRAPH RD STE 1100
BLOOMFIELD TOWNSHIP MI
48302-2080
US

IV. Provider business mailing address

1942 BLOOMFIELD DR
BLOOMFIELD HILLS MI
48302-0121
US

V. Phone/Fax

Practice location:
  • Phone: 248-660-9888
  • Fax:
Mailing address:
  • Phone: 586-604-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801108864
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: