Provider Demographics
NPI:1063777407
Name:BOROS, KERRI LYNN (MA, LPC,)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:BOROS
Suffix:
Gender:F
Credentials:MA, LPC,
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2839 GULFSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-6188
Mailing Address - Country:US
Mailing Address - Phone:989-780-2972
Mailing Address - Fax:
Practice Address - Street 1:2839 GULFSTREAM DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-6188
Practice Address - Country:US
Practice Address - Phone:989-780-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISC0000001092139101YS0200X
MI6401012572101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool