Provider Demographics
NPI:1457138513
Name:FRANCO, SELENE GUADALUPE (BS, LADC)
Entity Type:Individual
Prefix:
First Name:SELENE
Middle Name:GUADALUPE
Last Name:FRANCO
Suffix:
Gender:F
Credentials:BS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-2704
Mailing Address - Country:US
Mailing Address - Phone:651-424-5821
Mailing Address - Fax:
Practice Address - Street 1:7300 147TH ST W STE 600
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4517
Practice Address - Country:US
Practice Address - Phone:952-997-3020
Practice Address - Fax:952-997-3026
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306805101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)