Provider Demographics
NPI:1649087198
Name:BORER, DANI JADE
Entity type:Individual
Prefix:
First Name:DANI
Middle Name:JADE
Last Name:BORER
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4023
Mailing Address - Country:US
Mailing Address - Phone:858-243-3007
Mailing Address - Fax:
Practice Address - Street 1:75-5995 KUAKINI HWY STE 221
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2120
Practice Address - Country:US
Practice Address - Phone:808-465-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health