Active NPI
Ava Elizabeth Selke, MS, TLLP
- Clinical Psychologist
- Clarkston, MI
National Provider Identifier
1194215970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6362001113
- Practice address
- 6549 Town Center Dr Ste a
Clarkston, MI 48346-4824 - Phone
- (248) 620-6400
- NPI assigned
- May 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301018366 | MI | |
| Clinical Psychologist | 103TC0700X | 6362001113 | MI | Primary |
Addresses
Primary practice location
6549 Town Center Dr Ste a
Clarkston, MI 48346-4824
Mailing address
6549 Town Center Dr Ste a
Clarkston, MI 48346-4824
Phone (248) 620-6400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106S00000X | Other | MI | TAXONOMY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301018366 | MI | MD | Clinical Psychologist |
| 6362001113 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588204800000",
"number": "1194215970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6549 TOWN CENTER DR STE A",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483464824",
"telephone_number": "248-620-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6549 TOWN CENTER DR STE A",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483464824",
"telephone_number": "248-620-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELKE",
"first_name": "AVA",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"credential": "MS, TLLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-16",
"last_updated": "2020-04-30",
"certification_date": "2020-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301018366",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6362001113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAXONOMY",
"identifier": "106S00000X",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.