Healthcare Provider Details

I. General information

NPI: 1710778501
Provider Name (Legal Business Name): SELDEN PSYCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 MARKET ST STE 125, #307
PHILADELPHIA PA
19103
US

IV. Provider business mailing address

1735 MARKET ST STE 125, #307
PHILADELPHIA PA
19103
US

V. Phone/Fax

Practice location:
  • Phone: 267-209-3390
  • Fax: 267-930-6250
Mailing address:
  • Phone: 267-209-3390
  • Fax: 267-930-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAY SELDEN
Title or Position: OWNER
Credential:
Phone: 267-209-3390