Provider Demographics
NPI:1609351287
Name:SELAH BEHAVIORAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:SELAH BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:THORNBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:828-855-8170
Mailing Address - Street 1:521 TENBY DR APT 107
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-9254
Mailing Address - Country:US
Mailing Address - Phone:828-855-8170
Mailing Address - Fax:
Practice Address - Street 1:521 TENBY DR APT 107
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-9254
Practice Address - Country:US
Practice Address - Phone:828-855-8170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty