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General NPI Number Information
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NPI Number | 1184935330
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Entity Type | Individual
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Provider Name | EMILY MARIE SELBY-NELSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 6135 SISSONVILLE DR
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City | CHARLESTON
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State | WV
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Zip | 25312-9444
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Country | US
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Telephone | 304-388-9948
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Fax |
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Provider Business Mailing Address
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Address Line | 6135 SISSONVILLE DR
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City | CHARLESTON
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State | WV
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Zip | 25312-9444
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Country | US
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Telephone | 304-984-1576
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 11721681-2500
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1080
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License Number State | WV
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