Provider Demographics
NPI:1134601891
Name:BORNE, MEGHAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:
Last Name:BORNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3733
Mailing Address - Country:US
Mailing Address - Phone:504-475-7799
Mailing Address - Fax:
Practice Address - Street 1:1000 AIRBASE RD.
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:LA
Practice Address - Zip Code:71467
Practice Address - Country:US
Practice Address - Phone:504-475-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY644103TC0700X
LA1477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical