Basic Information
| Provider Information | |||||||||
| NPI: | 1104934843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SELINSKY | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, IMF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7420 WEST PKWY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958233027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169126311 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7000 FRANKLIN BLVD | ||||||||
| Address2: | SUITE 1230 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958231820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163942010 | ||||||||
| FaxNumber: | 9163942011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | IMF39028 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.