Active NPI
Charles Michael Borduin, PH.D.
- Clinical Child & Adolescent Psychologist
- Columbia, MO
National Provider Identifier
1720178239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 01144
- Practice address
- 211 S. 8TH Street
Psychological Services Clinic University of Missouri
Columbia, MO 65211 - Phone
- (573) 882-4677
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 01144 | MO | Primary |
Addresses
Primary practice location
211 S. 8TH Street
Psychological Services Clinic University of Missouri
Columbia, MO 65211
Mailing address
211 S. 8TH Street
Psychological Services Clinic University of Missouri
Columbia, MO 65211
Phone (573) 882-4677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01144 | MO | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720178239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 S. 8TH STREET",
"address_2": "PSYCHOLOGICAL SERVICES CLINIC UNIVERSITY OF MISSOURI",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "65211",
"telephone_number": "573-882-4677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 S. 8TH STREET",
"address_2": "PSYCHOLOGICAL SERVICES CLINIC UNIVERSITY OF MISSOURI",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "65211",
"telephone_number": "573-882-4677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORDUIN",
"first_name": "CHARLES",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MO",
"license": "01144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.