MEDICARE: PATTI F. BORNAMAN M.A.

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	483	LA

General Provider Information

NPI Number	:	1790798080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTI F. BORNAMAN M.A.

Provider Business Mailing Address
First Line	:	9435 MANSFIELD RD
Second Line	:	SUITE 3B
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3859
Country	:	US
Telephone Number	:	318-686-0012
Fax Number	:	318-686-0012

Provider Business Practice Location Address
First Line	:	9435 MANSFIELD RD
Second Line	:	SUITE 3B
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3859
Country	:	US
Telephone Number	:	318-686-0012
Fax Number	:	318-686-0012

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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