Healthcare Provider Details

I. General information

NPI: 1306986971
Provider Name (Legal Business Name): HEIDI R. BORDEN MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 SHELDON ST
CLOVIS NM
88101-6062
US

IV. Provider business mailing address

1316 SHELDON ST
CLOVIS NM
88101-6062
US

V. Phone/Fax

Practice location:
  • Phone: 575-799-1684
  • Fax:
Mailing address:
  • Phone: 575-700-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0123101
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0123101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: