Provider Demographics
NPI:1346413465
Name:SELVIG, MAUREEN MCKINNEY (LPC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MCKINNEY
Last Name:SELVIG
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 1:828 WEST OLIVE STREET
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521
Mailing Address - Country:US
Mailing Address - Phone:970-377-9520
Mailing Address - Fax:970-493-8009
Practice Address - Street 1:1302 SOUTH SHIELDS STREET
Practice Address - Street 2:SUITE A2-2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521
Practice Address - Country:US
Practice Address - Phone:970-377-9520
Practice Address - Fax:970-493-8009
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1255101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1255OtherLPC