Provider Demographics
NPI:1982772281
Name:BORRMANN, DAVID WILLIAM (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAM
Last Name:BORRMANN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8153 E ENCANTO ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-4902
Mailing Address - Country:US
Mailing Address - Phone:480-518-2289
Mailing Address - Fax:480-275-5236
Practice Address - Street 1:801 S POWER RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5207
Practice Address - Country:US
Practice Address - Phone:480-518-2289
Practice Address - Fax:480-275-5236
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 10613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ738883OtherAHCCCS PROVIDER ID