Provider Demographics
NPI:1487735502
Name:SELAH CHRISTIAN CENTER INC
Entity type:Organization
Organization Name:SELAH CHRISTIAN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TALITHA
Authorized Official - Middle Name:DAY
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:574-269-3008
Mailing Address - Street 1:201 N ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3849
Mailing Address - Country:US
Mailing Address - Phone:574-269-3008
Mailing Address - Fax:
Practice Address - Street 1:201 N ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3849
Practice Address - Country:US
Practice Address - Phone:574-269-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty