Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1239 | SC |
Y | 103T00000X | Psychologist | 1239 | SC |
NPI | 1003151978 |
---|---|
Provider Name | Jeffrey S Selman |
First Address | Sumter, SC 29150-1832 |
Second Address | Sumter, SC 29150-1832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2012 |
Last Update Date | 04/12/2012 |