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General NPI Number Information
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NPI Number | 1841597812
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Entity Type | Individual
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Provider Name | SUSAN LOUISE SELLERS BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/27/2011
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 6867 SOUTHPOINT DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8043
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Country | US
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Telephone | 904-619-6071
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Fax |
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Provider Business Mailing Address
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Address Line | 36 WALNUT AVE
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City | SHALIMAR
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State | FL
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Zip | 32579-1120
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Country | US
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Telephone | 850-420-2498
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-16-24495
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License Number State | FL
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