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General NPI Number Information
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NPI Number | 1124581160
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Entity Type | Individual
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Provider Name | SELENA MARIE GROOMS
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Gender | Female
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 30 S 4TH ST
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City | NEWARK
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State | OH
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Zip | 43055-5002
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Country | US
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Telephone | 380-201-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 140 E TOWN ST STE 1450
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City | COLUMBUS
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State | OH
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Zip | 43215-6601
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Country | US
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Telephone | 614-639-6590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | QMHS
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | OH
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