Provider Demographics
NPI:1487776597
Name:SELBY, THOMAS J (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:SELBY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:SELBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:14617 S 34TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7013
Mailing Address - Country:US
Mailing Address - Phone:480-759-7942
Mailing Address - Fax:602-955-3430
Practice Address - Street 1:2345 E THOMAS RD
Practice Address - Street 2:SUITE 385
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7848
Practice Address - Country:US
Practice Address - Phone:602-955-3429
Practice Address - Fax:602-955-3430
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1642103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist