Provider Demographics
NPI:1669996377
Name:PEET, SELINA AGNEW (MS)
Entity type:Individual
Prefix:MRS
First Name:SELINA
Middle Name:AGNEW
Last Name:PEET
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 LASALLE PATH
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-5286
Mailing Address - Country:US
Mailing Address - Phone:850-875-2422
Mailing Address - Fax:850-875-2124
Practice Address - Street 1:79 LASALLE PATH
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-5286
Practice Address - Country:US
Practice Address - Phone:850-875-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health