Provider Demographics
NPI:1992196505
Name:SELB, DERRICK
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:SELB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5266 HOLLISTER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2066
Mailing Address - Country:US
Mailing Address - Phone:805-538-2559
Mailing Address - Fax:
Practice Address - Street 1:3710 STATE ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6180
Practice Address - Country:US
Practice Address - Phone:805-538-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82923106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist