Provider Demographics
NPI:1689282261
Name:SELAH BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SELAH BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KALNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:717-507-3367
Mailing Address - Street 1:864 JAY ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-1924
Mailing Address - Country:US
Mailing Address - Phone:717-454-8379
Mailing Address - Fax:717-272-2474
Practice Address - Street 1:864 JAY ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-1924
Practice Address - Country:US
Practice Address - Phone:717-454-8379
Practice Address - Fax:717-272-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health