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General NPI Number Information
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NPI Number | 1831424852
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Entity Type | Individual
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Provider Name | TERALYN ANNE SELL LPC, CSAC, CSC-IT,
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Gender | Female
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 705 MANCHESTER RD
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City | NEENAH
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State | WI
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Zip | 54956-4909
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Country | US
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Telephone | 920-486-1373
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Fax |
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Provider Business Mailing Address
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Address Line | 705 MANCHESTER RD
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City | NEENAH
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State | WI
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Zip | 54956-4909
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Country | US
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Telephone | 920-486-1373
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15409-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15391-133
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4415-125
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License Number State | WI
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