Provider Demographics
NPI:1275224164
Name:PLATTE, SELINA
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:PLATTE
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:PO BOX 3141
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88221-3141
Mailing Address - Country:US
Mailing Address - Phone:575-725-5552
Mailing Address - Fax:575-725-5552
Practice Address - Street 1:1900 WESTRIDGE RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3550
Practice Address - Country:US
Practice Address - Phone:575-725-5552
Practice Address - Fax:575-725-5552
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health