Provider Demographics
NPI:1376667659
Name:SELBY, MARY JEAN (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:SELBY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JEANE
Other - Middle Name:
Other - Last Name:SELBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8 S MICHIGAN AVE STE 2005
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3342
Mailing Address - Country:US
Mailing Address - Phone:773-329-0995
Mailing Address - Fax:773-538-5305
Practice Address - Street 1:8 S MICHIGAN AVE STE 1500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3362
Practice Address - Country:US
Practice Address - Phone:312-630-9663
Practice Address - Fax:773-523-3718
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004609101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health