Provider Demographics
NPI:1942819958
Name:SHAY SELDEN, PSYD, MED, LLC
Entity Type:Organization
Organization Name:SHAY SELDEN, PSYD, MED, LLC
Other - Org Name:COLLAGE THERAPY COLLECTIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER & DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MED
Authorized Official - Phone:267-209-3390
Mailing Address - Street 1:100 S BROAD ST STE 834
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-1018
Mailing Address - Country:US
Mailing Address - Phone:267-209-3390
Mailing Address - Fax:267-930-6250
Practice Address - Street 1:100 S BROAD ST STE 834
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1018
Practice Address - Country:US
Practice Address - Phone:267-209-0010
Practice Address - Fax:267-930-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-26
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty