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General NPI Number Information
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NPI Number | 1689279143
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Entity Type | Organization
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Legal Business Name | ROBERT K BORNT
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 3684 MAIN ST APT 1
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City | HOMER
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State | AK
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Zip | 99603-7560
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Country | US
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Telephone | 907-342-2661
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3140
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City | HOMER
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State | AK
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Zip | 99603-3140
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Country | US
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Telephone | 907-342-2661
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. ROBERT K BORNT
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Credential | LMFT, CDC
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Telephone | 907-432-2661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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