MEDICARE: JIM BORGARDT LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC46040	CA
2	106H00000X	Marriage & Family Therapist	46040	CA

General Provider Information

NPI Number	:	1053435578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM BORGARDT LMFT

Provider Business Mailing Address
First Line	:	2801 OCEAN PARK BLVD # 346
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2905
Country	:	US
Telephone Number	:	424-229-2122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 OCEAN PARK BLVD # 346
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2905
Country	:	US
Telephone Number	:	424-229-2122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	05/09/2024

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