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General NPI Number Information
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NPI Number | 1669039012
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Entity Type | Individual
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Provider Name | TARENA MICHELE BORDEN MA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 9417 SAINT JOE CENTER RD
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City | FORT WAYNE
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State | IN
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Zip | 46835-9259
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Country | US
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Telephone | 260-370-6573
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 85
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City | GRABILL
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State | IN
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Zip | 46741-0085
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Country | US
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Telephone | 260-760-1836
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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