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General NPI Number Information
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NPI Number | 1760148373
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Entity Type | Individual
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Provider Name | NICOLE RUTH SELA
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Gender | Female
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 1224 W 40TH PL
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City | LOS ANGELES
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State | CA
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Zip | 90037-1702
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Country | US
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Telephone | 323-364-5152
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Fax |
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Provider Business Mailing Address
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Address Line | 1590 ROSECRANS SUITE D, #126
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266
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Country | US
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Telephone | 323-364-5152
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11463
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License Number State | CA
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