Individual
COREY BOREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
222 N HILLCREST DR, GRANBY, MO 64844-8198
(916) 893-4528
Mailing address
222 N HILLCREST DR, GRANBY, MO 64844-8198
(916) 893-4528
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
458632154989544
AR
101YM0800X
Mental Health Counselor
8469754655565
OK
103TC0700X
Clinical Psychologist
11564758-4805
UT
103TC0700X
Clinical Psychologist
Primary
4521033015
MO
103TC0700X
Clinical Psychologist
74125
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
458632154989544
—
AR
Enumeration date
08/02/2022
Last updated
04/25/2026
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