Provider Demographics
NPI:1902170160
Name:SAVELL, SELENA R
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:R
Last Name:SAVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:R
Other - Last Name:FLOREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88241-0907
Mailing Address - Country:US
Mailing Address - Phone:575-393-3168
Mailing Address - Fax:575-397-4659
Practice Address - Street 1:3821 W COLLEGE LN
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88242-9126
Practice Address - Country:US
Practice Address - Phone:575-392-2231
Practice Address - Fax:575-393-3168
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMCCMH0224461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83725873Medicaid