Provider Demographics
NPI:1548473580
Name:SELBY, HEIDI R
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:R
Last Name:SELBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 W DIVIDE AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1208
Mailing Address - Country:US
Mailing Address - Phone:701-328-8870
Mailing Address - Fax:701-328-8900
Practice Address - Street 1:919 S 7TH ST STE 303
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5835
Practice Address - Country:US
Practice Address - Phone:701-712-3290
Practice Address - Fax:701-712-3294
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ND1292-6-1-23A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator