Provider Demographics
NPI:1801814439
Name:SELBY, JEFFREY (MFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:SELBY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 E. MAIN STREET
Mailing Address - Street 2:#248
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-856-3321
Mailing Address - Fax:805-644-6212
Practice Address - Street 1:4360 E MAIN ST
Practice Address - Street 2:#248
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8279
Practice Address - Country:US
Practice Address - Phone:805-856-3321
Practice Address - Fax:805-644-6212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist