Provider Demographics
NPI:1336161231
Name:SELYA, MANUEL LINCOLN (PHD PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:LINCOLN
Last Name:SELYA
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGY
Other - Prefix:DR
Other - First Name:EMANUEL
Other - Middle Name:LINCOLN
Other - Last Name:SELYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD PSYCHOLOGY
Mailing Address - Street 1:120 CRESCENT BAY DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1321
Mailing Address - Country:US
Mailing Address - Phone:949-929-1143
Mailing Address - Fax:949-494-6255
Practice Address - Street 1:4199 CAMPUS DR
Practice Address - Street 2:350
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-4684
Practice Address - Country:US
Practice Address - Phone:949-929-1143
Practice Address - Fax:949-494-6255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical