Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1799 | AL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301012872 | MI |
NPI | 1003869116 |
---|---|
Provider Name | Michelle E Mastin |
First Address | Birmingham, AL 35233-1711 |
Second Address | Birmingham, AL 35233-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 18/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P108974770 | BCBS PERSONAL PIN (01) | MI |