| Doctor Name: | JIMMY SELANDERS |
| NPI Number: | 1265821102 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 200129910A |
| Business Practice Address: | 32300 S 625 Rd Grove, OK - 743446285 |
| Business Phone Number: | 9187862930 |
| Business Fax Number: | 9187865985 |
| Mailing Address: | Po Box 451585, GROVE |
| State: | OK |
| Postal Code: | 743451585 |
| Phone Number: | 9187862930 |
| Fax Number: | 9187865985 |
| NPI Enumeration Date: | 01/15/2015 |
| NPI Last Update Date: | 01/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 200129910A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |