=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124892419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLIYAH BORJAS LAC, LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2023
-----------------------------------------------------
Last Update Date | 11/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2017 LAVA LN
-----------------------------------------------------
City | ALAMOSA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81101-3578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-480-4043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2017 LAVA LN
-----------------------------------------------------
City | ALAMOSA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81101-3578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 0002332
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------