Provider Demographics
NPI:1063740454
Name:BOORD, NATASHA (LMSW)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:BOORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16802 N 31ST ST
Mailing Address - Street 2:#138
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2627
Mailing Address - Country:US
Mailing Address - Phone:623-326-1663
Mailing Address - Fax:
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:SUITE I-164
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-878-2100
Practice Address - Fax:623-776-9419
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-12337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker