Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 33784 | TX |
Y | 103T00000X | Psychologist | 33784 | TX |
NPI | 1003090747 |
---|---|
Provider Name | Connie Borden |
First Address | Plano, TX 75025-5833 |
Second Address | Mckinney, TX 75070-3310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2007 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33784 | LICENSE (01) | TX |