Provider Demographics
NPI:1326263435
Name:SELOVE, REBECCA (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SELOVE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 21ST AVE S
Mailing Address - Street 2:#227
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4942
Mailing Address - Country:US
Mailing Address - Phone:615-500-3981
Mailing Address - Fax:
Practice Address - Street 1:2200 21ST AVE S
Practice Address - Street 2:#227
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4942
Practice Address - Country:US
Practice Address - Phone:615-500-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002936103TC2200X, 103TB0200X, 103TF0000X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
R00794Medicare UPIN