Provider Demographics
NPI:1356995146
Name:BORNER, LAURA (MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BORNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12569 DANIELS GATE DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9420
Mailing Address - Country:US
Mailing Address - Phone:720-454-6210
Mailing Address - Fax:
Practice Address - Street 1:1745 SHEA CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-1540
Practice Address - Country:US
Practice Address - Phone:720-454-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0012626101YM0800X
COMFT.0001727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty