Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 3861 | AZ |
N | 103TC0700X | Clinical Psychologist | 3861 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0810002999 | VA |
N | 103TA0700X | Adult Development & Aging Psychologist | 0810002999 | VA |
Y | 103G00000X | Clinical Psychologist | 0810002999 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810002999 | VA |
N | 103TE1100X | Exercise & Sports Psychologist | 3861 | AZ |
N | 103TF0000X | Family Psychologist | 0810002999 | VA |
N | 103TF0200X | Forensic Psychologist | 0810002999 | VA |
N | 103TH0004X | Health Psychologist | 3861 | AZ |
N | 103TH0100X | Health Service | 0810002999 | VA |
N | 103TH0100X | Health Service | 3861 | AZ |
N | 103TP2701X | Group Psychotherapist | 0810002999 | VA |
N | 103TR0400X | Rehabilitation Psychologist | 0810002999 | VA |
N | 103TR0400X | Rehabilitation Psychologist | 3861 | AZ |
NPI | 1275696924 |
---|---|
Provider Name | Dr. Michael Angelo Borders |
First Address | Cochise, AZ 85606-8729 |
Second Address | Cochise, AZ 85606-8729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2006 |
Last Update Date | 31/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0810002999 | CLINICAL PSYCHOLOGY (01) | VA |
3861 | CLINICAL PSYCHOLOGY (01) | AZ |
44572 | NATIONAL REGISTER OF HEAL (01) | |
5302 | AMERICAN BOARD OF PROFESS (01) | |
8264 | AMERICAN COLLEGE OF FOREN (01) |