MEDICARE: MR. CHRISTOPHER JOHN BORDEN MA, LPC, CSAC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	15496-132	WI
2	101YP2500X	Professional Counselor	4738-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053551671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER JOHN BORDEN MA, LPC, CSAC, NCC

Provider Business Mailing Address
First Line	:	16535 W BLUEMOUND RD STE 200
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-5906
Country	:	US
Telephone Number	:	262-789-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 N GREEN BAY AVE STE 205
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-4446
Country	:	US
Telephone Number	:	262-789-1191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2009
Last Update Date	:	11/18/2024

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