Provider Demographics
NPI:1821136391
Name:SELBY, GAYLE A (MC)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:A
Last Name:SELBY
Suffix:
Gender:F
Credentials:MC
Other - Prefix:MS
Other - First Name:GAYLE
Other - Middle Name:A
Other - Last Name:SELBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MC
Mailing Address - Street 1:6619 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4421
Mailing Address - Country:US
Mailing Address - Phone:480-296-2050
Mailing Address - Fax:480-423-2365
Practice Address - Street 1:6619 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-4421
Practice Address - Country:US
Practice Address - Phone:480-296-2050
Practice Address - Fax:480-423-2365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional