Healthcare Provider Details

I. General information

NPI: 1851996524
Provider Name (Legal Business Name): SELAH COUNSELING & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W B ST STE H
SPRINGFIELD OR
97477-4575
US

IV. Provider business mailing address

PO BOX 852
SPRINGFIELD OR
97477-0142
US

V. Phone/Fax

Practice location:
  • Phone: 541-423-2633
  • Fax:
Mailing address:
  • Phone: 503-523-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES LENHART
Title or Position: OPERATION DIRECTOR
Credential:
Phone: 541-423-2622