MEDICARE: MR. DANIEL ANDREW SELOCK MS/CADC/LCPC

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	180006639	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180006639	OTHER	IL	STATE LICENSE, LCPC
2	03932079	OTHER	IL	BLUE CROSS BLUE SHIELD
3	11826508	OTHER	IL	CAQH

General Provider Information

NPI Number	:	1891872362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL ANDREW SELOCK MS/CADC/LCPC

Provider Business Mailing Address
First Line	:	70 SANDY PT
Second Line	:
City	:	GOREVILLE
State	:	IL
Zip	:	62939-3122
Country	:	US
Telephone Number	:	618-889-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 SANDY PT
Second Line	:
City	:	GOREVILLE
State	:	IL
Zip	:	62939-3122
Country	:	US
Telephone Number	:	618-889-3987
Fax Number	:	618-351-1419

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/05/2025

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Directions to “ MR. DANIEL ANDREW SELOCK MS/CADC/LCPC” Practice Location

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