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General NPI Number Information
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NPI Number | 1649168055
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Entity Type | Organization
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Legal Business Name | SELINA MATTHEWS
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1636 S BARRINGTON AVE SUITE 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-4822
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Country | US
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Telephone | 310-968-5750
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Fax | 903-487-0600
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Provider Business Mailing Address
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Address Line | 1636 S BARRINGTON AVE APT 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-4084
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Country | US
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Telephone | 310-968-5750
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Fax |
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Authorized Official
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Title or Position | OFFICE
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Name | BRITTAINY WAGNER
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Credential | LPC
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Telephone | 903-213-1005
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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 |
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License Number State |
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