Provider Demographics
NPI:1790191823
Name:SELLNER, MARTIN HARLEN
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:HARLEN
Last Name:SELLNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-1191
Mailing Address - Country:US
Mailing Address - Phone:218-251-6722
Mailing Address - Fax:218-444-9212
Practice Address - Street 1:51756 229TH AVE
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-9376
Practice Address - Country:US
Practice Address - Phone:218-444-9420
Practice Address - Fax:218-444-9212
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301726101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)