Provider Demographics
NPI:1508652611
Name:SELAH THERAPY SERVICES LLC
Entity type:Organization
Organization Name:SELAH THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-388-6448
Mailing Address - Street 1:9440 TEABERRY CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5672
Mailing Address - Country:US
Mailing Address - Phone:571-388-6448
Mailing Address - Fax:
Practice Address - Street 1:9440 TEABERRY CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5672
Practice Address - Country:US
Practice Address - Phone:571-388-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)