Provider Demographics
NPI:1699041335
Name:WHITTLE, SELENA (PHD, MS, LPC)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:PHD, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 NW BUTTERCUP DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3380
Mailing Address - Country:US
Mailing Address - Phone:503-908-1550
Mailing Address - Fax:
Practice Address - Street 1:3126 NW BUTTERCUP DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3380
Practice Address - Country:US
Practice Address - Phone:503-908-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2845103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling