Healthcare Provider Details

I. General information

NPI: 1285111633
Provider Name (Legal Business Name): KAITLYN SELSER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVER AVE
EUGENE OR
97404-2506
US

IV. Provider business mailing address

35 CLUB RD APT 412
EUGENE OR
97401-7949
US

V. Phone/Fax

Practice location:
  • Phone: 866-972-0235
  • Fax:
Mailing address:
  • Phone: 406-439-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC6106
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.011518
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: