Provider Demographics
NPI:1619301082
Name:SELENE CENTER
Entity Type:Organization
Organization Name:SELENE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-525-0117
Mailing Address - Street 1:374 N COAST HIGHWAY 101 STE F12
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2542
Mailing Address - Country:US
Mailing Address - Phone:760-525-0117
Mailing Address - Fax:760-436-1608
Practice Address - Street 1:374 N COAST HIGHWAY 101 STE F12
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2542
Practice Address - Country:US
Practice Address - Phone:760-525-0117
Practice Address - Fax:760-436-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health