Provider Demographics
NPI:1164508065
Name:SELVES, KATHY A
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:SELVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:SIMPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 420 BOX 2674
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:IMA-EUROPE ATTN: SFIM-EU-HR (SAIC-ASACS)
Practice Address - Street 2:UNIT 29353, BOX 200
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09014-9353
Practice Address - Country:US
Practice Address - Phone:49622-116-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00101651041C0700X
WALW083021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical