Provider Demographics
NPI:1568686335
Name:SELBY, DESIREE BOEHS (LPC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:BOEHS
Last Name:SELBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3842
Mailing Address - Country:US
Mailing Address - Phone:580-231-2020
Mailing Address - Fax:580-540-9819
Practice Address - Street 1:516 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3842
Practice Address - Country:US
Practice Address - Phone:580-231-2020
Practice Address - Fax:580-540-9819
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200410690AMedicaid