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General NPI Number Information
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NPI Number | 1447160155
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Entity Type | Organization
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Legal Business Name | SELAH WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 255 HIGHWAY 97 UNIT 1A
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City | FOREST LAKE
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State | MN
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Zip | 55025-2687
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Country | US
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Telephone | 320-372-2323
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Fax | 833-651-2526
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Provider Business Mailing Address
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Address Line | 501 MAIN ST
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City | SANDSTONE
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State | MN
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Zip | 55072-4410
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Country | US
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Telephone | 320-372-2323
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Fax | 833-651-2526
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Authorized Official
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Title or Position | CEO
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Name | NAOMI KOENIG
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Credential |
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Telephone | 320-372-2323
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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