Provider Demographics
NPI:1447560347
Name:SELIM, YASER (MFTI)
Entity Type:Individual
Prefix:
First Name:YASER
Middle Name:
Last Name:SELIM
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11780 CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-6498
Mailing Address - Country:US
Mailing Address - Phone:909-517-2020
Mailing Address - Fax:909-517-2022
Practice Address - Street 1:11780 CENTRAL AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-6499
Practice Address - Country:US
Practice Address - Phone:909-517-2020
Practice Address - Fax:909-517-2022
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF46825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist