Provider Demographics
NPI:1720959349
Name:SELOVER, THERESA ANNETTE
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNETTE
Last Name:SELOVER
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 1:410 VALLEY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2740
Mailing Address - Country:US
Mailing Address - Phone:925-216-6542
Mailing Address - Fax:
Practice Address - Street 1:2849 CALAIS DR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3116
Practice Address - Country:US
Practice Address - Phone:925-479-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool