MEDICARE: SELAH COUNSELING ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2007002225	MO

General Provider Information

NPI Number	:	1487934998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELAH COUNSELING ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	111 CHURCH ST STE 103
Second Line	:	SAINT LOUIS
City	:	SAINT LOUIS
State	:	MO
Zip	:	63135-2457
Country	:	US
Telephone Number	:	314-246-9270
Fax Number	:	866-524-0405

Provider Business Practice Location Address
First Line	:	111 CHURCH ST STE 103
Second Line	:	SAINT LOUIS
City	:	SAINT LOUIS
State	:	MO
Zip	:	63135-2457
Country	:	US
Telephone Number	:	314-246-9270
Fax Number	:	866-524-0405

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. LA SHAUNA ANINGO
Credential	:	LPC
Telephone Number	:	314-246-9270

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	08/29/2011

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