Provider Demographics
NPI:1780041632
Name:SELAH WELLNESS LLC
Entity Type:Organization
Organization Name:SELAH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA
Authorized Official - Phone:859-221-7975
Mailing Address - Street 1:448 BRECK AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1302
Mailing Address - Country:US
Mailing Address - Phone:859-221-7975
Mailing Address - Fax:
Practice Address - Street 1:448 BRECK AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1302
Practice Address - Country:US
Practice Address - Phone:859-221-7975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-23
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00224162251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health