Healthcare Provider Details

I. General information

NPI: 1427967660
Provider Name (Legal Business Name): MRS. AMANDA LYN BORLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SCIO RD. SW
CARROLLTON OH
44615
US

IV. Provider business mailing address

205 SCIO RD. SW
CARROLLTON OH
44615
US

V. Phone/Fax

Practice location:
  • Phone: 330-627-8067
  • Fax: 330-627-5215
Mailing address:
  • Phone: 330-627-8067
  • Fax: 330-627-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01824
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: