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General NPI Number Information
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NPI Number | 1487934998
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Entity Type | Organization
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Legal Business Name | SELAH COUNSELING ASSOCIATES LLC
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 111 CHURCH ST STE 103 SAINT LOUIS
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City | SAINT LOUIS
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State | MO
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Zip | 63135-2457
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Country | US
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Telephone | 314-246-9270
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Fax | 866-524-0405
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Provider Business Mailing Address
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Address Line | 111 CHURCH ST STE 103 SAINT LOUIS
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City | SAINT LOUIS
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State | MO
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Zip | 63135-2457
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Country | US
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Telephone | 314-246-9270
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Fax | 866-524-0405
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. LA SHAUNA ANINGO
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Credential | LPC
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Telephone | 314-246-9270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2007002225
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License Number State | MO
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