Provider Demographics
NPI:1104494301
Name:O'HAGAN, MARY BETH SELNER (PHD)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:SELNER
Last Name:O'HAGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 E YALE CIR STE 207
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6933
Mailing Address - Country:US
Mailing Address - Phone:303-918-9934
Mailing Address - Fax:
Practice Address - Street 1:5290 E YALE CIR STE 207
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6933
Practice Address - Country:US
Practice Address - Phone:303-918-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty