Provider Demographics
NPI:1770261745
Name:BORDERLANDS THERAPY COLLABORATIVE, PLLC
Entity type:Organization
Organization Name:BORDERLANDS THERAPY COLLABORATIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:REYNAGA
Authorized Official - Last Name:ABIKO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-493-1550
Mailing Address - Street 1:14150 NE 20TH ST # F1-126
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14150 NE 20TH ST # F1-126
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3700
Practice Address - Country:US
Practice Address - Phone:703-493-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty