Provider Demographics
NPI:1003090747
Name:BORDEN, CONNIE (PHD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:BORDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 COIT RD
Mailing Address - Street 2:STE 220-222
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5833
Mailing Address - Country:US
Mailing Address - Phone:972-800-3930
Mailing Address - Fax:214-975-2793
Practice Address - Street 1:1216 N CENTRAL EXPY
Practice Address - Street 2:STE 102
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3310
Practice Address - Country:US
Practice Address - Phone:972-800-3930
Practice Address - Fax:214-975-2793
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33784103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33784OtherLICENSE