Provider Demographics
NPI:1992999627
Name:SELBY PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:SELBY PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-262-9009
Mailing Address - Street 1:6 STATE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5112
Mailing Address - Country:US
Mailing Address - Phone:207-262-9009
Mailing Address - Fax:207-262-9008
Practice Address - Street 1:6 STATE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5112
Practice Address - Country:US
Practice Address - Phone:207-262-9009
Practice Address - Fax:207-262-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty