Provider Demographics
NPI:1336384486
Name:SELLERS, JAN BOSTON (PHD, LPC,)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:BOSTON
Last Name:SELLERS
Suffix:
Gender:F
Credentials:PHD, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:261 YVONNE AVENUE
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-0926
Mailing Address - Country:US
Mailing Address - Phone:931-456-2859
Mailing Address - Fax:931-797-8921
Practice Address - Street 1:261 YVONNE AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4735
Practice Address - Country:US
Practice Address - Phone:931-456-2859
Practice Address - Fax:931-797-8921
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health