Healthcare Provider Details

I. General information

NPI: 1356839567
Provider Name (Legal Business Name): SEAN KYLE BORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HUMPHREY RD STE 4
GREENSBURG PA
15601-4571
US

IV. Provider business mailing address

225 HUMPHREY RD STE 4
GREENSBURG PA
15601-4571
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-9096
  • Fax: 724-832-2249
Mailing address:
  • Phone: 724-832-9096
  • Fax: 724-832-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000998
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: