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NPI Code Detail

MEDICARE: KHALIO BORUM MS, LPC-IT

MEDICARE: KHALIO BORUM MS, LPC-IT
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
1101YM0800XMental Health Counselor4681-226WI

General Provider Information

NPI Number : 1225649684
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHALIO BORUM MS, LPC-IT
Provider Business Mailing Address
First Line : PO BOX 1115
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53052-1115
Country : US
Telephone Number : 414-435-0333
Fax Number :
Provider Business Practice Location Address
First Line : 4025 N 92ND ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-1613
Country : US
Telephone Number : 414-435-0333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2020
Last Update Date : 11/21/2022

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