MEDICARE: JACQUELINE MARIE BORGES LMFT

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	101YP2500X	Professional Counselor	MFC 48203	CA

General Provider Information

NPI Number	:	1851422141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MARIE BORGES LMFT

Provider Business Mailing Address
First Line	:	1724 EDGEWOOD DR
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95382-9250
Country	:	US
Telephone Number	:	209-668-3712
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E CANAL DR
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95380-3936
Country	:	US
Telephone Number	:	209-669-2583
Fax Number	:	209-669-2588

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	05/11/2010

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