Provider Demographics
NPI:1285388066
Name:SELBURN, HAILEY (MA)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:SELBURN
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 HIGHLAND OAKS ST
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-8093
Mailing Address - Country:US
Mailing Address - Phone:760-586-1168
Mailing Address - Fax:
Practice Address - Street 1:3375 MESA RIDGE RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6729
Practice Address - Country:US
Practice Address - Phone:760-916-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12477663103K00000X
106S00000X
CA12644106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician