Provider Demographics
NPI:1295254878
Name:SELOCHAN, NOELLE AMYRA (LMFT, RPT)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:AMYRA
Last Name:SELOCHAN
Suffix:
Gender:F
Credentials:LMFT, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 LOUISIANA AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2351
Mailing Address - Country:US
Mailing Address - Phone:407-960-2651
Mailing Address - Fax:
Practice Address - Street 1:1155 LOUISIANA AVE STE 216
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2351
Practice Address - Country:US
Practice Address - Phone:407-960-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT3214OtherFLORIDA LMFT