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General NPI Number Information
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NPI Number | 1811690944
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Entity Type | Organization
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Legal Business Name | INNER REACHES HEALING ARTS, LLC
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 4730 FERGUSON CORNERS RD
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City | RUSHVILLE
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State | NY
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Zip | 14544-9623
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Country | US
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Telephone | 716-785-4725
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 93
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City | RUSHVILLE
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State | NY
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Zip | 14544-0093
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | SHERRI LYNN BORGLUM
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Credential | LCAT
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Telephone | 716-785-4725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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