Provider Demographics
NPI:1134634819
Name:SEELEY, MANDY
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:SEELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 PLOVER ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-1939
Mailing Address - Country:US
Mailing Address - Phone:916-533-3349
Mailing Address - Fax:
Practice Address - Street 1:2753 PLOVER ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-1939
Practice Address - Country:US
Practice Address - Phone:916-533-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)