| NPI | 1902469513 |
|---|---|
| Former Name | SHELBY SELVIDGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2019-04-18 |