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General NPI Number Information
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NPI Number | 1255774154
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Entity Type | Individual
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Provider Name | JENNIFER L. SELBY CCAPP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 800 SCENIC DR # BLDNGF
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City | MODESTO
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State | CA
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Zip | 95350-6131
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Country | US
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Telephone | 209-525-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 800 SCENIC DR
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City | MODESTO
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State | CA
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Zip | 95350-6131
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Country | US
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Telephone | 209-525-6225
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AII056740518
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License Number State | CA
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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 | AII056740518
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number | S1103032139
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | AII056740518
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License Number State | CA
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