Provider Demographics
NPI:1598951659
Name:SELBY, KRISTIN W (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:W
Last Name:SELBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 TRIBUTE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4322
Mailing Address - Country:US
Mailing Address - Phone:916-924-6400
Mailing Address - Fax:
Practice Address - Street 1:1792 TRIBUTE RD STE 350
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4322
Practice Address - Country:US
Practice Address - Phone:916-924-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS186701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical