Provider Demographics
NPI:1770090011
Name:SELBE, MARY JO (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:SELBE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 VENABLE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1960
Mailing Address - Country:US
Mailing Address - Phone:304-619-8715
Mailing Address - Fax:
Practice Address - Street 1:305 20TH ST SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1003
Practice Address - Country:US
Practice Address - Phone:304-619-8715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-10-10
Deactivation Date:2020-01-30
Deactivation Code:
Reactivation Date:2024-10-10
Provider Licenses
StateLicense IDTaxonomies
WV2333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health