Provider Demographics
NPI:1356839567
Name:BORRIS, SEAN KYLE
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:KYLE
Last Name:BORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HUMPHREY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4571
Mailing Address - Country:US
Mailing Address - Phone:724-832-9096
Mailing Address - Fax:724-832-2249
Practice Address - Street 1:225 HUMPHREY RD STE 4
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4571
Practice Address - Country:US
Practice Address - Phone:724-832-9096
Practice Address - Fax:724-832-2249
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000998106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist