Healthcare Provider Details

I. General information

NPI: 1952233868
Provider Name (Legal Business Name): SELAH MARRIAGE AND FAMILY THERAPY, PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21771 STEVENS CREEK BLVD STE 200A
CUPERTINO CA
95014-1175
US

IV. Provider business mailing address

20289 STEVENS CREEK BLVD # 1127
CUPERTINO CA
95014-2258
US

V. Phone/Fax

Practice location:
  • Phone: 408-504-9128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: GANLIN CHEN
Title or Position: FOUNDER
Credential:
Phone: 408-504-9128