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General NPI Number Information
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NPI Number | 1487776597
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Entity Type | Individual
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Provider Name | THOMAS J. SELBY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2345 E THOMAS RD SUITE 385
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City | PHOENIX
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State | AZ
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Zip | 85016-7848
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Country | US
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Telephone | 602-955-3429
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Fax | 602-955-3430
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Provider Business Mailing Address
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Address Line | 14617 S 34TH PL
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City | PHOENIX
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State | AZ
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Zip | 85044-7013
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Country | US
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Telephone | 480-759-7942
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Fax | 602-955-3430
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1642
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License Number State | AZ
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