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General NPI Number Information
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NPI Number | 1376667659
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Entity Type | Individual
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Provider Name | MARY JEAN SELBY LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 8 S MICHIGAN AVE STE 1500
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City | CHICAGO
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State | IL
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Zip | 60603-3362
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Country | US
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Telephone | 312-630-9663
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Fax | 773-523-3718
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Provider Business Mailing Address
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Address Line | 8 S MICHIGAN AVE STE 2005
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City | CHICAGO
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State | IL
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Zip | 60603-3342
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Country | US
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Telephone | 773-329-0995
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Fax | 773-538-5305
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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 | 180004609
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180004609
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License Number State | IL
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