Provider Demographics
NPI:1225139611
Name:SELDEN, JOHN W (PHD LP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SELDEN
Suffix:
Gender:M
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 W 3RD AVE
Mailing Address - Street 2:RANGE MENTAL HEALTH CENTER INC PERPICH BUILDING
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746
Mailing Address - Country:US
Mailing Address - Phone:218-263-9237
Mailing Address - Fax:218-262-3150
Practice Address - Street 1:3203 W 3RD AVE
Practice Address - Street 2:RANGE MENTAL HEALTH CENTER INC PERPICH BUILDING
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-263-9237
Practice Address - Fax:218-262-3150
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical