Provider Demographics
NPI:1972888535
Name:BORDENKIRCHER, ANTHONY (LLMFT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BORDENKIRCHER
Suffix:
Gender:M
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1839
Mailing Address - Country:US
Mailing Address - Phone:616-594-0810
Mailing Address - Fax:
Practice Address - Street 1:36 W 8TH ST
Practice Address - Street 2:#250
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2701
Practice Address - Country:US
Practice Address - Phone:616-594-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist