Provider Demographics
NPI:1467090944
Name:BORER, ZACHARY (LMFT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:BORER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 S BEVERLY GLEN BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6136
Mailing Address - Country:US
Mailing Address - Phone:352-359-1611
Mailing Address - Fax:
Practice Address - Street 1:1614 S BEVERLY GLEN BLVD APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-6136
Practice Address - Country:US
Practice Address - Phone:352-359-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist