Provider Demographics
NPI:1689279143
Name:ROBERT K BORNT
Entity Type:Organization
Organization Name:ROBERT K BORNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:BORNT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CDC
Authorized Official - Phone:907-432-2661
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-3140
Mailing Address - Country:US
Mailing Address - Phone:907-342-2661
Mailing Address - Fax:
Practice Address - Street 1:3684 MAIN ST APT 1
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7560
Practice Address - Country:US
Practice Address - Phone:907-342-2661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty