Basic Information
| Provider Information | |||||||||
| NPI: | 1427302454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOREEN | ||||||||
| FirstName: | HARLAND | ||||||||
| MiddleName: | TRAVIS | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 9TH STREET CDCR | ||||||||
| Address2: | CLIENT FINANCIAL SERVICES, ROOM 205 MAIL STOP: 2-3 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 942442020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599927100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 QUEBEC AVE | ||||||||
| Address2: | MENTAL HEALTH STAFF | ||||||||
| City: | CORCORAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932129715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599927100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2012 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY23431 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TM1800X | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 103TF0200X | N | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No ID Information.