Provider Demographics
NPI:1053435578
Name:BORGARDT, JIM (LMFT)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:BORGARDT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:BORGARDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:2801 OCEAN PARK BLVD # 346
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2905
Mailing Address - Country:US
Mailing Address - Phone:424-229-2122
Mailing Address - Fax:
Practice Address - Street 1:2801 OCEAN PARK BLVD # 346
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2905
Practice Address - Country:US
Practice Address - Phone:424-229-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46040106H00000X
CA46040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist