Healthcare Provider Details

I. General information

NPI: 1730885716
Provider Name (Legal Business Name): MICHAEL BORUM ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 S 51ST ST STE 125
PHOENIX AZ
85044-5226
US

IV. Provider business mailing address

10201 S 51ST ST STE 125
PHOENIX AZ
85044-5226
US

V. Phone/Fax

Practice location:
  • Phone: 602-475-8702
  • Fax: 602-742-2793
Mailing address:
  • Phone: 602-475-8702
  • Fax: 602-742-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: