Provider Demographics
NPI:1578868907
Name:TASTAN, SELIN (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SELIN
Middle Name:
Last Name:TASTAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:SELIN
Other - Middle Name:
Other - Last Name:SERTGOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 HUFF AVE. (KREINBROOK PSYCOLOGICAL SERVICES)
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-836-4662
Mailing Address - Fax:
Practice Address - Street 1:11020 S TRYON ST STE 408
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6662
Practice Address - Country:US
Practice Address - Phone:704-237-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-15
Last Update Date:2019-02-12
Deactivation Date:2011-05-18
Deactivation Code:
Reactivation Date:2017-12-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional