MEDICARE: KRISTA BORGWARDT THERAPY, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	7150	NE
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	11164	NE

General Provider Information

NPI Number	:	1851829170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTA BORGWARDT THERAPY, LLC

Provider Business Mailing Address
First Line	:	3031 S 87TH ST UNIT 2
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3042
Country	:	US
Telephone Number	:	14027399820
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 S 87TH ST UNIT 2
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3042
Country	:	US
Telephone Number	:	14027399820
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MENTAL HEALTH THERAPIST
Name	:	KRISTA BORGWARDT
Credential	:	PLMHP, PCMSW
Telephone Number	:	402-739-9820

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	05/31/2017

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