Provider Demographics
NPI:1841485968
Name:WESLEY, SELMA DIAN (LCSW)
Entity type:Individual
Prefix:
First Name:SELMA
Middle Name:DIAN
Last Name:WESLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-4006
Mailing Address - Country:US
Mailing Address - Phone:314-423-2354
Mailing Address - Fax:314-423-2354
Practice Address - Street 1:3624 GORDON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4006
Practice Address - Country:US
Practice Address - Phone:314-423-2354
Practice Address - Fax:314-423-2354
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health