Provider Demographics
NPI:1972838761
Name:SHELLEY, SELENA B (MA,LMHC, CD, LCCE)
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:B
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:MA,LMHC, CD, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 NE 128TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6314
Mailing Address - Country:US
Mailing Address - Phone:425-213-3807
Mailing Address - Fax:
Practice Address - Street 1:11415 NE 128TH ST STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6314
Practice Address - Country:US
Practice Address - Phone:425-213-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WALH60858843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374J00000XNursing Service Related ProvidersDoula