Healthcare Provider Details

I. General information

NPI: 1144146465
Provider Name (Legal Business Name): SELAH COUNSELING COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 WILLOW TREE CIR STE 102
CORDOVA TN
38018-3118
US

IV. Provider business mailing address

882 WILLOW TREE CIR STE 102
CORDOVA TN
38018-3118
US

V. Phone/Fax

Practice location:
  • Phone: 901-670-7412
  • Fax:
Mailing address:
  • Phone: 901-670-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY TAWFIK
Title or Position: OWNER
Credential: LPC-MHSP
Phone: 901-670-7412