MEDICARE: LAURA ANN BOROS MA LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6361004931	MI
2	103TC0700X	Clinical Psychologist	6361004931	MI

General Provider Information

NPI Number	:	1386801777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANN BOROS MA LLP

Provider Business Mailing Address
First Line	:	14799 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14799 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2507
Country	:	US
Telephone Number	:	734-239-0434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	06/10/2024

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