Healthcare Provider Details

I. General information

NPI: 1972838761
Provider Name (Legal Business Name): SELENA B SHELLEY MA,LMHC, CD, LCCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11415 NE 128TH ST STE 100
KIRKLAND WA
98034-6314
US

IV. Provider business mailing address

11415 NE 128TH ST STE 100
KIRKLAND WA
98034-6314
US

V. Phone/Fax

Practice location:
  • Phone: 425-213-3807
  • Fax:
Mailing address:
  • Phone: 425-213-3807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60858843
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: