Provider Demographics
NPI:1013148634
Name:BEHAVIORAL HEALTH OF SELMA, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH OF SELMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST / EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-877-3322
Mailing Address - Street 1:1306 OLD ORRVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6931
Mailing Address - Country:US
Mailing Address - Phone:334-877-3322
Mailing Address - Fax:334-877-3322
Practice Address - Street 1:1306 OLD ORRVILLE RD
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6931
Practice Address - Country:US
Practice Address - Phone:334-877-3322
Practice Address - Fax:334-877-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000113523Medicaid
AL102G683343Medicare PIN