Provider Demographics
NPI:1730762477
Name:BORER, DYLAN LAWRENCE (LMHCA)
Entity type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:LAWRENCE
Last Name:BORER
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ELLIOTT AVE W STE 500
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4292
Mailing Address - Country:US
Mailing Address - Phone:402-750-3608
Mailing Address - Fax:
Practice Address - Street 1:101 ELLIOTT AVE W STE 500
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4292
Practice Address - Country:US
Practice Address - Phone:402-750-3608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA101YM0800X, 106S00000X
WAMC61282676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician