Provider Demographics
NPI:1376429415
Name:VERBIEST, SELENA LEIGH
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:LEIGH
Last Name:VERBIEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 13TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-2852
Mailing Address - Country:US
Mailing Address - Phone:239-896-8150
Mailing Address - Fax:
Practice Address - Street 1:1705 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1195
Practice Address - Country:US
Practice Address - Phone:888-872-0459
Practice Address - Fax:888-391-5328
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1379796106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician