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General NPI Number Information
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NPI Number | 1144236142
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Entity Type | Individual
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Provider Name | AMY BORST MFT, ATR
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 23161 MILL CREEK DR SUITE # 335
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-7908
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Country | US
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Telephone | 949-547-9876
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 74122
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-0138
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC39153
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License Number State | CA
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