Provider Demographics
NPI:1205947793
Name:SELZ, MARION J (PH D)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:J
Last Name:SELZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 E PIMA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3663
Mailing Address - Country:US
Mailing Address - Phone:520-408-8814
Mailing Address - Fax:520-323-1336
Practice Address - Street 1:5363 E PIMA ST
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3663
Practice Address - Country:US
Practice Address - Phone:520-408-8814
Practice Address - Fax:520-323-1336
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ801103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A18477Medicare UPIN
AZ103481Medicare ID - Type Unspecified