Healthcare Provider Details

I. General information

NPI: 1700699378
Provider Name (Legal Business Name): ZACHARY BORDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZAK BORDEN MA

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6536 SE DUKE ST STE 6
PORTLAND OR
97206-6665
US

IV. Provider business mailing address

6536 SE DUKE ST STE 6
PORTLAND OR
97206-6665
US

V. Phone/Fax

Practice location:
  • Phone: 503-389-5682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9856
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: