Provider Demographics
NPI:1932485588
Name:BORGELT, CARLY OLIVE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:OLIVE
Last Name:BORGELT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 N ASSEMBLY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6185
Mailing Address - Country:US
Mailing Address - Phone:509-596-9450
Mailing Address - Fax:509-434-7156
Practice Address - Street 1:155 MAIN ST #C
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-0324
Practice Address - Country:US
Practice Address - Phone:208-476-4230
Practice Address - Fax:208-476-4281
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31463104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No104100000XBehavioral Health & Social Service ProvidersSocial Worker