Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2009026784 | MO |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2009026784 | MO |
N | 103G00000X | Clinical Psychologist | 2009026784 | MO |
N | 103TC0700X | Clinical Psychologist | 2009026784 | MO |
Y | 103G00000X | Clinical Psychologist | PY11082 | FL |
Y | 103TC0700X | Clinical Psychologist | PY11082 | FL |
N | 103TP2701X | Group Psychotherapist | 2009026784 | MO |
NPI | 1003149576 |
---|---|
Provider Name | Dr. Michael J. Bachop |
First Address | Palmetto, FL 34221-4737 |
Second Address | Arcadia, FL 34266-8752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2009 |
Last Update Date | 27/05/2021 |