| Doctor Name: | RITA KAY SELF |
| NPI Number: | 1003946708 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. |
| License Number: | |
| Business Practice Address: | 3010 E State Blvd Fort Wayne, IN - 468054700 |
| Business Phone Number: | 2604712300 |
| Business Fax Number: | 2604712778 |
| Mailing Address: | 2301 Lynn Ave, FORT WAYNE |
| State: | IN |
| Postal Code: | 468053742 |
| Phone Number: | 2604827871 |
| Fax Number: | 2607450405 |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |