Provider Demographics
NPI:1649705781
Name:BORNE, MYRA
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:BORNE
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 1:374 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:EDGARD
Mailing Address - State:LA
Mailing Address - Zip Code:70049-2524
Mailing Address - Country:US
Mailing Address - Phone:504-491-6063
Mailing Address - Fax:
Practice Address - Street 1:2979 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:EDGARD
Practice Address - State:LA
Practice Address - Zip Code:70049-2508
Practice Address - Country:US
Practice Address - Phone:504-491-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health