Provider Demographics
NPI:1558956334
Name:SELDERS, ANGELA Y (MHS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:Y
Last Name:SELDERS
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 GENOLA RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-5601
Mailing Address - Country:US
Mailing Address - Phone:225-654-5743
Mailing Address - Fax:
Practice Address - Street 1:4336 NORTH BLVD STE 204
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3920
Practice Address - Country:US
Practice Address - Phone:225-960-7419
Practice Address - Fax:225-960-7421
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor