Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1063017259 |
---|---|
Provider Name | Dr. Michael Selby |
First Address | San Luis Obispo, CA 93401-3711 |
Second Address | San Luis Obispo, CA 93401-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2020 |
Last Update Date | 03/12/2020 |