Provider Demographics
NPI:1720608318
Name:SELBY, JORDAN LEE (LPC, LMAC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:SELBY
Suffix:
Gender:F
Credentials:LPC, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1818
Mailing Address - Country:US
Mailing Address - Phone:785-260-6688
Mailing Address - Fax:785-408-5485
Practice Address - Street 1:1401 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1818
Practice Address - Country:US
Practice Address - Phone:785-260-6688
Practice Address - Fax:785-408-5485
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS738101YA0400X
KS3239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)