Healthcare Provider Details

I. General information

NPI: 1609461706
Provider Name (Legal Business Name): LAUREN BORDES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 W CLARKSTON RD
LAKE ORION MI
48362-2893
US

IV. Provider business mailing address

169 W CLARKSTON RD
LAKE ORION MI
48362-2893
US

V. Phone/Fax

Practice location:
  • Phone: 248-431-8873
  • Fax:
Mailing address:
  • Phone: 248-431-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087779
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: