Healthcare Provider Details

I. General information

NPI: 1235361619
Provider Name (Legal Business Name): MICHAEL ROBERT TEMPLE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 03/10/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 MEDICAL GROUP UNIT 3215, RAMSTEIN AB
APO AE
09094
US

IV. Provider business mailing address

86 MEDICAL GROUP UNIT 3215, RAMSTEIN AB
APO AE
09094
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2390
  • Fax:
Mailing address:
  • Phone: 314-479-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1704
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1704
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: