Ethan Selvig LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1686 Issued in CO

Legal business name

ETHAN SELVIG LLC

Practice address

80 Garden Ctr Ste 222
Broomfield, CO 80020-1735

Phone

(724) 713-1016

NPI assigned

Oct 25, 2016

Organization subpart

No

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

Authorized official

Name

Ethan Selvig

Title

Owner

Phone

(724) 713-1016

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1417409442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 GARDEN CTR STE 222",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800201735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 GARDEN CTR STE 222",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800201735",
            "telephone_number": "724-713-1016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHAN SELVIG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-25",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "SELVIG",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-713-1016"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CO",
            "license": "1686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Community/Behavioral Health Agency in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.