Provider Demographics
NPI:1063017259
Name:SELBY, MICHAEL (PHD, MCP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SELBY
Suffix:
Gender:M
Credentials:PHD, MCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 LEFF ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3711
Mailing Address - Country:US
Mailing Address - Phone:805-439-0377
Mailing Address - Fax:
Practice Address - Street 1:1201 LEFF ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3711
Practice Address - Country:US
Practice Address - Phone:805-439-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral