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NPI Code Detail

MEDICARE: SELIA GAMBRELL

MEDICARE: SELIA GAMBRELL
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
1106S00000XBehavior Technician4101007649MI

General Provider Information

NPI Number : 1699336693
Entity Type Code : Individual
Provider Name (Legal Business Name) : SELIA GAMBRELL
Provider Business Mailing Address
First Line : 5675 FAIRVIEW ST
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-1033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5675 FAIRVIEW ST
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-1033
Country : US
Telephone Number : 269-429-7727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2019
Last Update Date : 03/27/2026

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Directions to “ SELIA GAMBRELL ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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