Provider Demographics
NPI:1740095090
Name:ELYSIAN WELLNESS
Entity type:Organization
Organization Name:ELYSIAN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:304-521-8490
Mailing Address - Street 1:3237 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-9116
Mailing Address - Country:US
Mailing Address - Phone:606-615-6989
Mailing Address - Fax:
Practice Address - Street 1:3237 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-9116
Practice Address - Country:US
Practice Address - Phone:606-615-6989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty