Provider Demographics
NPI:1932981131
Name:KIRK-SELVESTER, SHELLY D (SUDP-T)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:D
Last Name:KIRK-SELVESTER
Suffix:
Gender:F
Credentials:SUDP-T
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:D
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:21120 MERIDIAN AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8254
Mailing Address - Country:US
Mailing Address - Phone:253-285-4750
Mailing Address - Fax:
Practice Address - Street 1:21120 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8254
Practice Address - Country:US
Practice Address - Phone:253-285-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)