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General NPI Number Information
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NPI Number | 1215171509
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Entity Type | Organization
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Legal Business Name | SELAH COUNSELING, LLC
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 1320 VERMILLION STREET
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City | HASTINGS
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State | MN
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Zip | 55033-2870
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Country | US
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Telephone | 651-437-2881
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Fax | 651-437-3436
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Provider Business Mailing Address
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Address Line | 1320 VERMILLION ST
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City | HASTINGS
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State | MN
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Zip | 55033-2870
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Country | US
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Telephone | 651-437-2881
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Fax | 651-437-3436
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Authorized Official
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Title or Position | OWNER
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Name | ROBIN C RICARD
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Credential | MA LMFT
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Telephone | 651-437-2881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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