Healthcare Provider Details

I. General information

NPI: 1134814049
Provider Name (Legal Business Name): ALEC WEISS BORGEN JD, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEC WEISS BORGEN

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E EDGAR ST
SEATTLE WA
98102-3132
US

IV. Provider business mailing address

124 E EDGAR ST
SEATTLE WA
98102-3132
US

V. Phone/Fax

Practice location:
  • Phone: 510-463-4334
  • Fax:
Mailing address:
  • Phone: 510-463-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC.61615176
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: