Organization
SECOND CHANCE MINISERIES WELKLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREY WAYNE BOREN PYSD (DR)
(916) 893-4528
Entity
Organization
Contact information
Practice address
289 N 19TH AVE APT 52, LEMOORE, CA 93245-2573
(805) 800-8209
Mailing address
289 N 19TH AVE APT 52, LEMOORE, CA 93245-2573
(805) 800-8209
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Enumeration date
08/06/2022
Last updated
08/06/2022
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