Individual
JIMMY SELANDERS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
32300 S 625 RD, GROVE, OK 74344-6285
(918) 786-2930
(918) 786-5985
Mailing address
PO BOX 451585, GROVE, OK 74345-1585
(918) 786-2930
(918) 786-5985
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
200129910A
OK
Other
Enumeration date
01/15/2015
Last updated
01/15/2015
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