Provider Demographics
NPI:1083714729
Name:MOSELEY, SELONDA (LCSW)
Entity Type:Individual
Prefix:
First Name:SELONDA
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-0397
Mailing Address - Country:US
Mailing Address - Phone:405-521-8779
Mailing Address - Fax:
Practice Address - Street 1:600 NW 23RD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1469
Practice Address - Country:US
Practice Address - Phone:405-521-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746300 DMedicaid
OK100746300 DMedicaid
248313701Medicare PIN