Provider Demographics
NPI:1194583708
Name:SEL ACADEMY
Entity type:Organization
Organization Name:SEL ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TASCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUST
Authorized Official - Suffix:
Authorized Official - Credentials:NCSP
Authorized Official - Phone:507-407-3535
Mailing Address - Street 1:1448 ARDEN PL
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3664
Mailing Address - Country:US
Mailing Address - Phone:507-407-3535
Mailing Address - Fax:
Practice Address - Street 1:1448 ARDEN PL
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-3664
Practice Address - Country:US
Practice Address - Phone:507-407-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty