Provider Demographics
NPI:1083232987
Name:SELVON-SEMIN, SANDRA INDIANA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:INDIANA
Last Name:SELVON-SEMIN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 RAIL WAY UNIT 418
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-6441
Mailing Address - Country:US
Mailing Address - Phone:719-287-9645
Mailing Address - Fax:
Practice Address - Street 1:19039 PLAZA DR STE 295
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-8704
Practice Address - Country:US
Practice Address - Phone:719-287-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0019691101YM0800X
CO16457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty