Healthcare Provider Details

I. General information

NPI: 1134601891
Provider Name (Legal Business Name): MEGHAN BORNE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AIRBASE RD.
POLLOCK LA
71467
US

IV. Provider business mailing address

6509 COLISEUM BLVD
ALEXANDRIA LA
71303-3733
US

V. Phone/Fax

Practice location:
  • Phone: 504-475-7799
  • Fax:
Mailing address:
  • Phone: 504-475-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number644
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1477
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: