Basic Information
| Provider Information | |||||||||
| NPI: | 1851563365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SELMAN | ||||||||
| FirstName: | DARYL | ||||||||
| MiddleName: | EVELYN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 791749 | ||||||||
| Address2: | |||||||||
| City: | PAIA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967791749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085798414 | ||||||||
| FaxNumber: | 8085798426 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 IKE DR | ||||||||
| Address2: | |||||||||
| City: | MAKAWAO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967689718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085798414 | ||||||||
| FaxNumber: | 8085798426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2008 | ||||||||
| LastUpdateDate: | 04/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT-106 | HI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 1041C0700X | LCSW 3486 | HI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.