Provider Demographics
NPI:1386862357
Name:SELEZNYEV, YEVGENIYA
Entity Type:Individual
Prefix:MS
First Name:YEVGENIYA
Middle Name:
Last Name:SELEZNYEV
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 1:1318 N ORANGE DR APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7571
Mailing Address - Country:US
Mailing Address - Phone:323-962-4493
Mailing Address - Fax:
Practice Address - Street 1:14558 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2324
Practice Address - Country:US
Practice Address - Phone:818-787-4151
Practice Address - Fax:818-787-2840
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)