MEDICARE: JOSE E SELLES M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1629492590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE E SELLES M.S.W.

Provider Business Mailing Address
First Line	:	4121 MISSION CT
Second Line	:	APT NO. 308
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-1842
Country	:	US
Telephone Number	:	407-692-4676
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 MISSION CT
Second Line	:	APT NO. 308
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-1842
Country	:	US
Telephone Number	:	407-692-4676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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