Healthcare Provider Details

I. General information

NPI: 1578495867
Provider Name (Legal Business Name): SIERRA IRELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SPRUCE ST
SUPERIOR MT
59872-3027
US

IV. Provider business mailing address

PO BOX 266
SUPERIOR MT
59872-0266
US

V. Phone/Fax

Practice location:
  • Phone: 406-207-8710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-81229
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: