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General NPI Number Information
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NPI Number | 1184022105
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Entity Type | Organization
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Legal Business Name | INNER LIGHT COUNSELING, LLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 61 E 1ST S
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City | SODA SPRINGS
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State | ID
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Zip | 83276
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Country | US
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Telephone | 208-425-6932
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Fax | 435-417-3113
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Provider Business Mailing Address
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Address Line | 61 E 1ST S
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City | SODA SPRINGS
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State | ID
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Zip | 83276-1437
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Country | US
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Telephone | 208-425-6932
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Fax | 435-417-3113
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | SHERIE ANN FLAGG
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Credential | LCSW
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Telephone | 208-425-6932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 80117423501
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License Number State | UT
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