Provider Demographics
NPI:1336703487
Name:SELLIN, JOLYN E (LMSW)
Entity Type:Individual
Prefix:
First Name:JOLYN
Middle Name:E
Last Name:SELLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JOLYN
Other - Middle Name:E
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:702 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-3121
Mailing Address - Country:US
Mailing Address - Phone:208-454-2766
Mailing Address - Fax:208-454-2771
Practice Address - Street 1:2609 S 10TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6885
Practice Address - Country:US
Practice Address - Phone:208-454-2766
Practice Address - Fax:208-454-2771
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-34457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health