Healthcare Provider Details

I. General information

NPI: 1245838606
Provider Name (Legal Business Name): CAROL LYNN BORDEN PH.D., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL LUNDBERG

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 GALAXIE AVE STE 305
APPLE VALLEY MN
55124-4530
US

IV. Provider business mailing address

4240 PARK GLEN RD
ST LOUIS PARK MN
55416-5427
US

V. Phone/Fax

Practice location:
  • Phone: 952-432-1484
  • Fax: 952-432-2328
Mailing address:
  • Phone: 612-925-6033
  • Fax: 612-925-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3949
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: