Provider Demographics
NPI:1316144827
Name:SELPH, RICHARD BRACKETT (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRACKETT
Last Name:SELPH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BRAC
Other - Middle Name:
Other - Last Name:SELPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2142 SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3120
Mailing Address - Country:US
Mailing Address - Phone:415-307-2722
Mailing Address - Fax:
Practice Address - Street 1:2142 SUTTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3120
Practice Address - Country:US
Practice Address - Phone:415-935-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist