Provider Demographics
NPI:1215110747
Name:SELHA, MYKE (LISW)
Entity type:Individual
Prefix:
First Name:MYKE
Middle Name:
Last Name:SELHA
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 WOLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-1860
Mailing Address - Country:US
Mailing Address - Phone:515-991-9269
Mailing Address - Fax:
Practice Address - Street 1:3714 WOLCOTT AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-1860
Practice Address - Country:US
Practice Address - Phone:515-991-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA65381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical