Provider Demographics
NPI:1710293287
Name:SELDERS, LAURA JANE (MA, PC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JANE
Last Name:SELDERS
Suffix:
Gender:F
Credentials:MA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 COUNTY ROAD 203
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:OH
Mailing Address - Zip Code:45889
Mailing Address - Country:US
Mailing Address - Phone:419-306-3017
Mailing Address - Fax:
Practice Address - Street 1:701 JEFFERSON AVE STE 301
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-6957
Practice Address - Country:US
Practice Address - Phone:419-321-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health