Individual provider Active NPI

Racheal Borum, LPC

  • Counselor
  • Phoenix, AZ
National Provider Identifier
1457094021
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
LPC-22757 Issued in AZ
Practice address
3033 N Central Ave Ste 700
Phoenix, AZ 85012-2806
Phone
(602) 230-7373
Fax
(602) 257-8029
NPI assigned
Apr 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X LPC-22757 AZ Primary

Addresses

Primary practice location

3033 N Central Ave Ste 700
Phoenix, AZ 85012-2806

Mailing address

3101 N Central Ave Ste 550
Phoenix, AZ 85012-2635
Phone (602) 230-7373

Other practice location 1

2204 S Dobson Rd Ste 102
Mesa, AZ 85202-6457
Phone (602) 230-7373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240717002651 AZ Practitioner - Mental Health Counselor 5092250738 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC-22757AZMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Denova Collaborative Health, LLC Current Accepting new patients
Denova Collaborative Health, LLC CurrentSince Jul 3, 2024 Accepting new patients
Denova Collaborative Health, LLC CurrentSince Jul 3, 2024 Accepting new patients

Locations

2204 S Dobson Rd
Ste 102
Mesa, AZ 85202

3620 N 3rd St
Phoenix, AZ 85012
Phone (602) 329-8250

3033 N Central Ave
Ste 700
Phoenix, AZ 85012
Phone (602) 281-7289

3101 N Central Ave
Ste 500
Phoenix, AZ 85012

3101 N Central Ave
Ste 550
Phoenix, AZ 85012

610 E Baseline Rd
Ste 5
Phoenix, AZ 85042

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1457094021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 N CENTRAL AVE STE 550",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122635",
            "telephone_number": "602-230-7373",
            "fax_number": "602-628-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 N CENTRAL AVE STE 700",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122806",
            "telephone_number": "602-230-7373",
            "fax_number": "602-257-8029"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2204 S Dobson Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852026457",
            "country_code": "US",
            "telephone_number": "602-230-7373",
            "fax_number": "480-628-8577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORUM",
        "first_name": "RACHEAL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-20",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AZ",
            "license": "LPC-22757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.