Provider Demographics
NPI:1770685778
Name:SELNA, KEVIN JAY (MA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAY
Last Name:SELNA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16352 BIRDIE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2759
Mailing Address - Country:US
Mailing Address - Phone:714-840-7584
Mailing Address - Fax:
Practice Address - Street 1:2099 S STATE COLLEGE BLVD
Practice Address - Street 2:#250
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-6142
Practice Address - Country:US
Practice Address - Phone:714-704-5900
Practice Address - Fax:714-978-3419
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist