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General NPI Number Information
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NPI Number | 1336384486
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Entity Type | Individual
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Provider Name | JAN BOSTON SELLERS PHD, LPC,
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Gender | Female
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 261 YVONNE AVE
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City | CROSSVILLE
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State | TN
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Zip | 38555-4735
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Country | US
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Telephone | 931-456-2859
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Fax | 931-797-8921
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Provider Business Mailing Address
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Address Line | PO BOX 926 261 YVONNE AVENUE
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City | CROSSVILLE
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State | TN
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Zip | 38557-0926
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Country | US
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Telephone | 931-456-2859
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Fax | 931-797-8921
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0000002383
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License Number State | TN
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