Provider Demographics
NPI:1659869287
Name:SELL, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 QUINN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOOD PARKDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97041-7634
Mailing Address - Country:US
Mailing Address - Phone:314-306-7457
Mailing Address - Fax:
Practice Address - Street 1:512 CASCADE AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2126
Practice Address - Country:US
Practice Address - Phone:314-306-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5804101YP2500X
WALH61090547101YP2500X
MO2015042593101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional