Provider Demographics
NPI:1730629221
Name:BORJON, KELSEY
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:BORJON
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:PSC 2 BOX 5916
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0060
Mailing Address - Country:US
Mailing Address - Phone:0160-296-2055
Mailing Address - Fax:
Practice Address - Street 1:PSC 2 BOX 5916
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09012-0060
Practice Address - Country:US
Practice Address - Phone:0160-296-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ0-16-7481106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst