Provider Demographics
NPI:1629492590
Name:SELLES, JOSE E (MSW)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:SELLES
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 MISSION CT
Mailing Address - Street 2:APT NO. 308
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-1842
Mailing Address - Country:US
Mailing Address - Phone:407-692-4676
Mailing Address - Fax:
Practice Address - Street 1:4121 MISSION CT
Practice Address - Street 2:APT NO. 308
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-1842
Practice Address - Country:US
Practice Address - Phone:407-692-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional