Provider Demographics
NPI:1124338223
Name:SELOVER, KELLY (LPCC-S, NCC, CDCA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SELOVER
Suffix:
Gender:F
Credentials:LPCC-S, NCC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-0383
Mailing Address - Country:US
Mailing Address - Phone:937-426-2113
Mailing Address - Fax:937-426-2114
Practice Address - Street 1:7905 SCHATZ POINTE DR STE 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-0001
Practice Address - Country:US
Practice Address - Phone:937-426-2113
Practice Address - Fax:937-426-2114
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0700326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health