Individual
JACK SELBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1816 N 2ND ST, ATCHISON, KS 66002-1004
(913) 367-1618
(913) 367-6224
Mailing address
1816 N 2ND ST, ATCHISON, KS 66002-1004
(913) 367-1618
(913) 367-6224
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LMLP0209, LCP334
KS
Other
Enumeration date
10/04/2007
Last updated
10/04/2007
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