Provider Demographics
NPI:1215590237
Name:SELTNER, KASEY LYNN (LGPC)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:LYNN
Last Name:SELTNER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E WILT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2710
Mailing Address - Country:US
Mailing Address - Phone:215-687-2911
Mailing Address - Fax:
Practice Address - Street 1:2057 PULASKI HWY STE 4
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3744
Practice Address - Country:US
Practice Address - Phone:443-877-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional