Basic Information
Provider Information
NPI: 1033558564
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SELSER
FirstName: ROBERT
MiddleName: LINDSEY
NamePrefix: MR.
NameSuffix:  
Credential: MA, LPC, NCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 CROSSROADS DRIVE
Address2:  
City: OAKDALE
State: PA
PostalCode: 15071
CountryCode: US
TelephoneNumber: 7243078020
FaxNumber:  
Practice Location
Address1: 1000 CROSSROADS DRIVE
Address2:  
City: OAKDALE
State: PA
PostalCode: 15071
CountryCode: US
TelephoneNumber: 7243078020
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2013
LastUpdateDate: 01/13/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XPC006981PAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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