Kathlne May Born, LISAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

10955 Issued in AZ

Practice address

943 S Gilbert Rd Ste 204
Mesa, AZ 85204-4441

Phone

(480) 507-8619

Fax

(480) 507-8618

NPI assigned

Mar 18, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Family Service Agency

  • Community/Behavioral Health Agency
  • Mesa, AZ
  • NPI 1740487222
  NPD (past)

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268870400000",
    "number": "1811211808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 N CENTRAL AVE STE 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041315",
            "telephone_number": "480-507-8619",
            "fax_number": "480-507-8618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 S GILBERT RD STE 204",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852044441",
            "telephone_number": "480-507-8619",
            "fax_number": "480-507-8618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORN",
        "first_name": "KATHLNE",
        "middle_name": "MAY",
        "name_prefix": "Mrs.",
        "credential": "LISAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "10955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "#101YM0800X",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Booth
• Summer Cheyenne Booth, DDS
• Lori Marie Bordenave, PT
• Kenneth R Boren, M.D.
• Thomas Boren
• Karyn Rae Borrego, LPC
• David William Borrmann, M.A.
• Douglas Borrmann, LPC
• Soraly Borroto
• Vanessa Borunda

• Mental Health Counselor in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.