Provider Demographics
NPI:1982319786
Name:NGUYEN, SELENA
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CAHUILLA ST APT 105
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4747
Mailing Address - Country:US
Mailing Address - Phone:626-274-6884
Mailing Address - Fax:
Practice Address - Street 1:9327 MIDLOTHIAN TPKE STE 1D
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4965
Practice Address - Country:US
Practice Address - Phone:951-900-4414
Practice Address - Fax:951-880-0817
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional