Provider Demographics
NPI:1417354770
Name:THE PSYCHOLOGY PRACTICE OF MICHAEL G. SELDERS, PH.D., PLLC
Entity Type:Organization
Organization Name:THE PSYCHOLOGY PRACTICE OF MICHAEL G. SELDERS, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SELDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:469-766-2351
Mailing Address - Street 1:11551 FOREST CENTRAL DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3920
Mailing Address - Country:US
Mailing Address - Phone:214-553-7730
Mailing Address - Fax:214-553-7736
Practice Address - Street 1:11551 FOREST CENTRAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3920
Practice Address - Country:US
Practice Address - Phone:214-553-7730
Practice Address - Fax:214-553-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34549103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty