MEDICARE: JSS BEHAVIORAL SERVICES

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1932567195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSS BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	7301 RIVERS AVE
Second Line	:	SUITE 100
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-4650
Country	:	US
Telephone Number	:	843-637-4211
Fax Number	:	843-793-3691

Provider Business Practice Location Address
First Line	:	7301 RIVERS AVE
Second Line	:	SUITE 100
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-4650
Country	:	US
Telephone Number	:	843-637-4211
Fax Number	:	843-793-3691

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JEFFREY S SELMAN
Credential	:	PSYD
Telephone Number	:	843-637-4211

Provider Enumeration Date	:	02/03/2016
Last Update Date	:	02/03/2016

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