Provider Demographics
NPI:1851725501
Name:BOREN, KEVIN RAY (LMHC, CDP, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:RAY
Last Name:BOREN
Suffix:
Gender:M
Credentials:LMHC, CDP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 BONDGARD AVE E
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-7395
Mailing Address - Country:US
Mailing Address - Phone:208-369-6134
Mailing Address - Fax:
Practice Address - Street 1:15455 65TH AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:206-721-5170
Practice Address - Fax:206-721-6288
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60714217101YA0400X
WALH60728818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)