Provider Demographics
NPI:1750826467
Name:BORNE, JONAH
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:
Last Name:BORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EDGARD
Mailing Address - State:LA
Mailing Address - Zip Code:70049-2354
Mailing Address - Country:US
Mailing Address - Phone:985-210-7233
Mailing Address - Fax:
Practice Address - Street 1:300 E 5TH ST
Practice Address - Street 2:
Practice Address - City:EDGARD
Practice Address - State:LA
Practice Address - Zip Code:70049-2354
Practice Address - Country:US
Practice Address - Phone:985-210-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor