Provider Demographics
NPI:1609258391
Name:BOREN, KATHI
Entity type:Individual
Prefix:
First Name:KATHI
Middle Name:
Last Name:BOREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 S HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-4412
Mailing Address - Country:US
Mailing Address - Phone:806-202-8681
Mailing Address - Fax:
Practice Address - Street 1:514 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-3152
Practice Address - Country:US
Practice Address - Phone:806-202-8681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2763101YP2500X
CO0013651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional