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Individual
DR. SELENE LOUISE MITLYNG
Active
Individual
DR. SELENE LOUISE MITLYNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY13251
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OPL13250
—
CA
01
—
OPL132510
BLUE SHIELD
CA
Enumeration date
01/09/2007
Last updated
08/06/2007
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