Provider Demographics
NPI:1568634061
Name:SELIX, DEBI M (LMP)
Entity Type:Individual
Prefix:
First Name:DEBI
Middle Name:M
Last Name:SELIX
Suffix:
Gender:F
Credentials:LMP
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 1154
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-1154
Mailing Address - Country:US
Mailing Address - Phone:253-381-4298
Mailing Address - Fax:
Practice Address - Street 1:28610 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:SUITE 120
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8199
Practice Address - Country:US
Practice Address - Phone:253-381-4298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007682174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00007682OtherSTATE LICENSE LMP