Individual provider Active NPI

Gary S Selof

  • Marriage & Family Therapist
  • Ankeny, IA
National Provider Identifier
1154094878
Registry record updated Jan 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
000417 Issued in IA
Practice address
1850 SW Plaza Shops LN Ste D
Ankeny, IA 50023-7168
Phone
(515) 508-1150
NPI assigned
Jul 28, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 000417 IA
Marriage & Family Therapist 106H00000X 000417 IA Primary

Addresses

Primary practice location

1850 SW Plaza Shops LN Ste D
Ankeny, IA 50023-7168

Mailing address

1401 Westside Dr
Polk City, IA 50226-1014
Phone (515) 971-3792

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240511000325 IA Practitioner - Marriage and Family Therapist 3173964921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2012
Medicare assignment
May accept Medicare assignment
Group practices
New Hope Counseling Coaching and Consulting PCGroup PAC ID 5890134050, 13 clinicians

Practice addresses (Care Compare)

2540 106TH St
Suite 101
Urbandale, IA 50322-3736
Phone (515) 949-6918

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
000417IAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ankeny Family Counseling Mental Health CurrentSince Oct 24, 2021 Accepting new patients
New Hope Counseling, Coaching & Consulting P.C. Mental Health CurrentSince May 5, 2024 Accepting new patients

Locations

1850 SW Plaza Shops Ln
Ste D
Ankeny, IA 50023
Phone (515) 228-6596

1370 NW 114th St
Ste 309
Clive, IA 50325
Phone (515) 949-6918

113 Avenue O W
Fort Dodge, IA 50501
Phone (515) 332-8154

4502 Avenue O
Ste 8
Fort Madison, IA 52627

2540 106th St
Ste 101
Urbandale, IA 50322
Phone (515) 276-5543

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735689600000",
    "number": "1154094878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 WESTSIDE DR",
            "city": "POLK CITY",
            "state": "IA",
            "postal_code": "502261014",
            "telephone_number": "515-971-3792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 SW PLAZA SHOPS LN STE D",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500237168",
            "telephone_number": "515-508-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELOF",
        "first_name": "GARY",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-28",
        "last_updated": "2025-01-01",
        "certification_date": "2025-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "000417",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IA",
            "license": "000417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

Verify at the official NPI Registry.