Basic Information
| Provider Information | |||||||||
| NPI: | 1265838387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SELAH COUNSELING & WELLNESS CENTRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73 | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760630073 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12850 HILLCREST RD | ||||||||
| Address2: | SUITE F206 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752301529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724048253 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2014 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | SOILEAU | ||||||||
| AuthorizedOfficialFirstName: | CHRISTA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 9725229193 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 37028 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.