Provider Demographics
NPI:1548606650
Name:RILEY, SELINA ANN (BHRS)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:ANN
Last Name:RILEY
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2806
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-2806
Mailing Address - Country:US
Mailing Address - Phone:918-231-5648
Mailing Address - Fax:
Practice Address - Street 1:1843 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4610
Practice Address - Country:US
Practice Address - Phone:918-712-8800
Practice Address - Fax:918-712-8802
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor