Provider Demographics
NPI:1851008007
Name:SELAH CENTER FOR GRIEF AND LOSS LLC
Entity Type:Organization
Organization Name:SELAH CENTER FOR GRIEF AND LOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMMELROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:218-590-4199
Mailing Address - Street 1:1001 E 9TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 E 9TH ST STE 111
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1604
Practice Address - Country:US
Practice Address - Phone:218-590-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty