Provider Demographics
NPI:1922106558
Name:SELLEN, ZELDA FAITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ZELDA
Middle Name:FAITH
Last Name:SELLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W PITTSBURG ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4965
Mailing Address - Country:US
Mailing Address - Phone:918-258-5989
Mailing Address - Fax:
Practice Address - Street 1:1600 W PITTSBURG ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4965
Practice Address - Country:US
Practice Address - Phone:918-258-5989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical