Provider Demographics
NPI:1164769014
Name:BORLAND, JENNIFER (LCSW, CAS, MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BORLAND
Suffix:
Gender:F
Credentials:LCSW, CAS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OLD TOWN SQ STE 238
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2471
Mailing Address - Country:US
Mailing Address - Phone:720-592-7209
Mailing Address - Fax:
Practice Address - Street 1:19 OLD TOWN SQ STE 238
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2471
Practice Address - Country:US
Practice Address - Phone:720-592-7209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008586101YA0400X
COACC.0998586101YA0400X
COCSW.099236631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09923663OtherDORA - STATE LICENSE
COCSW.09923663OtherDORA - STATE LICENSE