Healthcare Provider Details

I. General information

NPI: 1093625451
Provider Name (Legal Business Name): RICHARD ANTHONY SELLERS ALC06191
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 18TH ST W
JASPER AL
35501-5363
US

IV. Provider business mailing address

61 TRINITY LN
JASPER AL
35504-4256
US

V. Phone/Fax

Practice location:
  • Phone: 205-582-4345
  • Fax:
Mailing address:
  • Phone: 205-582-4345
  • Fax: 205-582-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC06191
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: