Provider Demographics
NPI:1285111633
Name:SELSER, KAITLYN (LPC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SELSER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CLUB RD APT 412
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7949
Mailing Address - Country:US
Mailing Address - Phone:406-439-0220
Mailing Address - Fax:
Practice Address - Street 1:3 RIVER AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2506
Practice Address - Country:US
Practice Address - Phone:866-972-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6106101YM0800X
IL180.011518101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor