Provider Demographics
NPI:1659334944
Name:BORRESON, MARLYS ANN (LCPC)
Entity Type:Individual
Prefix:
First Name:MARLYS
Middle Name:ANN
Last Name:BORRESON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N 4TH ST
Mailing Address - Street 2:SUITE 205B
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6001
Mailing Address - Country:US
Mailing Address - Phone:208-368-7800
Mailing Address - Fax:
Practice Address - Street 1:200 N 4TH ST
Practice Address - Street 2:SUITE 205B
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6001
Practice Address - Country:US
Practice Address - Phone:208-368-7800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health