Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY 60063517 | WA |
N | 103G00000X | Clinical Psychologist | PY 60063517 | WA |
N | 103TC0700X | Clinical Psychologist | PY 60063517 | WA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY 60063517 | WA |
NPI | 1053518795 |
---|---|
Provider Name | Dr. Michael A. Archer |
First Address | Carnation, WA 98014-9644 |
Second Address | Issaquah, WA 98027-8127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 17/08/2016 |