MEDICARE: JOHN SELL

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	C5804	OR
2	101YP2500X	Professional Counselor	LH61090547	WA
3	101YP2500X	Professional Counselor	2015042593	MO

General Provider Information

NPI Number	:	1659869287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN SELL

Provider Business Mailing Address
First Line	:	5310 QUINN DR
Second Line	:
City	:	MOUNT HOOD PARKDALE
State	:	OR
Zip	:	97041-7634
Country	:	US
Telephone Number	:	314-306-7457
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 CASCADE AVE STE 100
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-2126
Country	:	US
Telephone Number	:	314-306-7457
Fax Number	:

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

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	07/04/2023

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Directions to “ JOHN SELL ” Practice Location

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