| Doctor Name: | JACK SELBERG |
| NPI Number: | 1124216130 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | LMLP0209, LCP334 |
| Business Practice Address: | 1816 N 2nd St Atchison, KS - 660021004 |
| Business Phone Number: | 9133671618 |
| Business Fax Number: | 9133676224 |
| Mailing Address: | 1816 N 2nd St, ATCHISON |
| State: | KS |
| Postal Code: | 660021004 |
| Phone Number: | 9133671618 |
| Fax Number: | 9133676224 |
| NPI Enumeration Date: | 10/04/2007 |
| NPI Last Update Date: | 10/04/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LMLP0209, LCP334 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |