Provider Demographics
NPI:1780023796
Name:SELBE, JAMIE MARLO (RLSW/RECREATION DIRE)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MARLO
Last Name:SELBE
Suffix:
Gender:F
Credentials:RLSW/RECREATION DIRE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16560 167TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2904
Mailing Address - Country:US
Mailing Address - Phone:440-228-4132
Mailing Address - Fax:
Practice Address - Street 1:16560 167TH ST SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:440-228-4132
Practice Address - Fax:440-275-2055
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1200224101Y00000X, 104100000X
KS2010053172V00000X
OH2010053172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker