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General NPI Number Information
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NPI Number | 1386558609
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Entity Type | Individual
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Provider Name | JIREH SELENA TOBON
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Gender | Female
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 450 FRANKLIN GATEWAY SE UNIT 160
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 678-968-5019
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Fax |
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Provider Business Mailing Address
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Address Line | 131 WALTHALL AVE SE
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City | MARIETTA
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State | GA
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Zip | 30060
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Country | US
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Telephone | 321-830-5459
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-26-522747
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License Number State | GA
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