Provider Demographics
NPI:1497213789
Name:BORLAND, ASHA (PLPC, ATC)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:BORLAND
Suffix:
Gender:F
Credentials:PLPC, ATC
Other - Prefix:
Other - First Name:ASHA
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 E BROADWAY STE 304
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4469
Mailing Address - Country:US
Mailing Address - Phone:630-923-9516
Mailing Address - Fax:
Practice Address - Street 1:601 E BROADWAY STE 304
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4469
Practice Address - Country:US
Practice Address - Phone:630-923-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MO2024039490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer