Provider Demographics
NPI:1447333208
Name:SELIG, KAREN GAIL (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:GAIL
Last Name:SELIG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S PONCE DE LEON BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-6013
Mailing Address - Country:US
Mailing Address - Phone:904-824-7733
Mailing Address - Fax:904-829-9768
Practice Address - Street 1:1100 S PONCE DE LEON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6013
Practice Address - Country:US
Practice Address - Phone:904-824-7733
Practice Address - Fax:904-829-9768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT128101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75181ZMedicare ID - Type Unspecified