Provider Demographics
NPI:1275029431
Name:SELAH, LLC
Entity Type:Organization
Organization Name:SELAH, LLC
Other - Org Name:SELAH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:720-772-8872
Mailing Address - Street 1:2568 CUTTERS CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7509
Mailing Address - Country:US
Mailing Address - Phone:720-772-8872
Mailing Address - Fax:
Practice Address - Street 1:19751 E MAINSTREET STE 225
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7428
Practice Address - Country:US
Practice Address - Phone:720-772-8872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========Medicaid