Provider Demographics
NPI:1295049948
Name:SELBY, JULIE ANNE (LPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:SELBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 COMMON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5207
Mailing Address - Country:US
Mailing Address - Phone:337-436-3700
Mailing Address - Fax:337-436-3772
Practice Address - Street 1:1039 COMMON ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5207
Practice Address - Country:US
Practice Address - Phone:337-436-3700
Practice Address - Fax:337-436-3772
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health