Healthcare Provider Details

I. General information

NPI: 1124841549
Provider Name (Legal Business Name): SELINA FIELD M.ED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NE KELLY AVE
GRESHAM OR
97030-5629
US

IV. Provider business mailing address

912 NE KELLY AVE
GRESHAM OR
97030-5629
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 855-772-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10228190
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: