Provider Demographics
NPI:1790122570
Name:SELTZER III, DONALD LUKE MILLER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DONALD LUKE MILLER
Middle Name:
Last Name:SELTZER III
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LUKE
Other - Middle Name:MILLER
Other - Last Name:SELTZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1619 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4015
Mailing Address - Country:US
Mailing Address - Phone:714-485-7949
Mailing Address - Fax:
Practice Address - Street 1:1619 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4015
Practice Address - Country:US
Practice Address - Phone:714-485-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94023140103TC0700X
CA31511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical