| Selah Academy, Incorporated | |
|
1991 W 39th Ct Fl 2 Gary IN 46408-2474 | |
| (219) 980-7919 | |
| Not Available |
| Full Name | Selah Academy, Incorporated |
|---|---|
| Speciality | Psychologist |
| Location | 1991 W 39th Ct Fl 2, Gary, Indiana |
| Authorized Official Name and Position | Aquanatte M Ruffin (PROGRAM DIRECTOR) |
| Authorized Official Contact | 2199807919 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Selah Academy, Incorporated Po Box 15090 Gary IN 46409-5090 Ph: (219) 980-7919 | Selah Academy, Incorporated 1991 W 39th Ct Fl 2 Gary IN 46408-2474 Ph: (219) 980-7919 |
| NPI Number | 1164588745 |
|---|---|
| Provider Enumeration Date | 12/28/2006 |
| Last Update Date | 08/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164588745 | NPI | - | NPPES |
| 200818150 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 20041315A (Indiana) | Primary |
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