Provider Demographics
NPI:1235161639
Name:BORSES, MEL (LMFT)
Entity Type:Individual
Prefix:
First Name:MEL
Middle Name:
Last Name:BORSES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16645 VINTAGE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91343-1152
Mailing Address - Country:US
Mailing Address - Phone:818-366-1390
Mailing Address - Fax:818-698-0444
Practice Address - Street 1:16645 VINTAGE ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91343-1152
Practice Address - Country:US
Practice Address - Phone:818-366-1390
Practice Address - Fax:818-698-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31567106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3357-01OtherPACIFICARE BEHVIORAL HEAL
CA66714OtherMANAGED HEALTH NETWORK
CAZZZ53132ZOtherBLUE SHIELD OF CALIFORNIA