Healthcare Provider Details

I. General information

NPI: 1811690944
Provider Name (Legal Business Name): INNER REACHES HEALING ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 FERGUSON CORNERS RD
RUSHVILLE NY
14544-9623
US

IV. Provider business mailing address

PO BOX 93
RUSHVILLE NY
14544-0093
US

V. Phone/Fax

Practice location:
  • Phone: 716-785-4725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHERRI LYNN BORGLUM
Title or Position: ORGANIZER
Credential: LCAT
Phone: 716-785-4725