Provider Demographics
NPI:1265838387
Name:SELAH COUNSELING & WELLNESS CENTRE
Entity type:Organization
Organization Name:SELAH COUNSELING & WELLNESS CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:972-522-9193
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12850 HILLCREST RD
Practice Address - Street 2:SUITE F206
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1529
Practice Address - Country:US
Practice Address - Phone:972-404-8253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty