Healthcare Provider Details
I. General information
NPI: 1275696924
Provider Name (Legal Business Name): MICHAEL ANGELO BORDERS PSY.D., ABPP, FAACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/17/2006
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3300 N MESQUITE RD
COCHISE AZ
85606-8729
US
IV. Provider business mailing address
3300 N MESQUITE RD
COCHISE AZ
85606-8729
US
V. Phone/Fax
- Phone: 520-826-0299
- Fax: 520-826-0300
- Phone: 520-826-0299
- Fax: 520-826-0300
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0004X |
| Taxonomy | Health Psychologist |
| License Number | 3861 |
| License Number State | AZ |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TE1100X |
| Taxonomy | Exercise & Sports Psychologist |
| License Number | 3861 |
| License Number State | AZ |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TR0400X |
| Taxonomy | Rehabilitation Psychologist |
| License Number | 3861 |
| License Number State | AZ |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103G00000X |
| Taxonomy | Clinical Neuropsychologist |
| License Number | 3861 |
| License Number State | AZ |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Psychologist |
| License Number | 0810002999 |
| License Number State | VA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0700X |
| Taxonomy | Adult Development & Aging Psychologist |
| License Number | 0810002999 |
| License Number State | VA |
| # 7 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 0810002999 |
| License Number State | VA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0000X |
| Taxonomy | Family Psychologist |
| License Number | 0810002999 |
| License Number State | VA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0200X |
| Taxonomy | Forensic Psychologist |
| License Number | 0810002999 |
| License Number State | VA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0100X |
| Taxonomy | Health Service Psychologist |
| License Number | 0810002999 |
| License Number State | VA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0100X |
| Taxonomy | Health Service Psychologist |
| License Number | 3861 |
| License Number State | AZ |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TP2701X |
| Taxonomy | Group Psychotherapy Psychologist |
| License Number | 0810002999 |
| License Number State | VA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TR0400X |
| Taxonomy | Rehabilitation Psychologist |
| License Number | 0810002999 |
| License Number State | VA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171000000X |
| Taxonomy | Military Health Care Provider |
| License Number | 3861 |
| License Number State | AZ |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171W00000X |
| Taxonomy | Contractor |
| License Number | 3861 |
| License Number State | AZ |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
