Provider Demographics
NPI:1467915629
Name:KRADOLFER, SELENA ISELA (LMFT)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:ISELA
Last Name:KRADOLFER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:ISELA
Other - Last Name:KRADOLFER SCANLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:13027 VICTORY BLVD # 458
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13027 VICTORY BLVD # 458
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2925
Practice Address - Country:US
Practice Address - Phone:747-977-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132377101Y00000X, 106H00000X, 106H00000X
CA115623101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist