Provider Demographics
NPI:1205928892
Name:SELBY, TOVA BETH (LPC,CDC1)
Entity type:Individual
Prefix:MS
First Name:TOVA
Middle Name:BETH
Last Name:SELBY
Suffix:
Gender:F
Credentials:LPC,CDC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E MARYDALE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7648
Mailing Address - Country:US
Mailing Address - Phone:907-260-3691
Mailing Address - Fax:907-260-3697
Practice Address - Street 1:230 E MARYDALE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7648
Practice Address - Country:US
Practice Address - Phone:907-260-3691
Practice Address - Fax:907-260-3697
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK475101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0156Medicaid
AKMH0156Medicaid