MEDICARE: JEFFREY T BORNSTEIN MS, LPCC

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	101YM0800X	Mental Health Counselor	64697	TX
2	101YM0800X	Mental Health Counselor	423	CA

General Provider Information

NPI Number	:	1053620732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY T BORNSTEIN MS, LPCC

Provider Business Mailing Address
First Line	:	4620 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5408
Country	:	US
Telephone Number	:	323-362-6555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4620 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5408
Country	:	US
Telephone Number	:	323-362-6555
Fax Number	:

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	12/17/2015

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