| Name: | Behavioral Health of Selma, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 02 Apr 2009 (16 years ago) |
| Entity Number: | 000-432-212 |
| Register Number: | 000432212 |
| County: | Dallas |
| Place of Formation: | Dallas County |
| Principal Address: | SELMA, AL |
| Registered Office Street Address: | 1306 ORVILLE RDSELMA, AL 36701 |
| Registered Office Street Address ZIP Code: | 36701 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013148634 | 2009-07-30 | 2009-10-06 | 1306 OLD ORRVILLE RD, SELMA, AL, 367016931, US | 1306 OLD ORRVILLE RD, SELMA, AL, 367016931, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 334-877-3322 |
| Fax | 3348773322 |
Authorized person
| Name | DR. RICHARD STEVEN REYNOLDS |
| Role | LICENSED PSYCHOLOGIST / EXECUTIVE |
| Phone | 3348773322 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| License Number | 835 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000113523 |
| State | AL |
| Name | Role |
|---|---|
| REYNOLDS, RICHARD S | Agent |
| Name | Role |
|---|---|
| REYNOLDS, RICHARD S | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
