Healthcare Provider Details

I. General information

NPI: 1114510203
Provider Name (Legal Business Name): HOPE BORDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOPE MARKS

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 9TH ST
JASPER IN
47546-2516
US

IV. Provider business mailing address

800 W 9TH ST
JASPER IN
47546-2516
US

V. Phone/Fax

Practice location:
  • Phone: 812-996-0437
  • Fax: 812-996-0439
Mailing address:
  • Phone: 812-996-0437
  • Fax: 812-996-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33010071A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010344A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: