Provider Demographics
NPI:1184022105
Name:INNER LIGHT COUNSELING, LLC
Entity Type:Organization
Organization Name:INNER LIGHT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-425-6932
Mailing Address - Street 1:61 E 1ST S
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-1437
Mailing Address - Country:US
Mailing Address - Phone:208-425-6932
Mailing Address - Fax:435-417-3113
Practice Address - Street 1:61 E 1ST S
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276
Practice Address - Country:US
Practice Address - Phone:208-425-6932
Practice Address - Fax:435-417-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT801174235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty