Healthcare Provider Details

I. General information

NPI: 1326263435
Provider Name (Legal Business Name): REBECCA SELOVE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 21ST AVE S #227
NASHVILLE TN
37212-4942
US

IV. Provider business mailing address

2200 21ST AVE S #227
NASHVILLE TN
37212-4942
US

V. Phone/Fax

Practice location:
  • Phone: 615-500-3981
  • Fax:
Mailing address:
  • Phone: 615-500-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP0000002936
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberP0000002936
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberP0000002936
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberP0000002936
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0000002936
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: