Healthcare Provider Details

I. General information

NPI: 1053518795
Provider Name (Legal Business Name): MICHAEL A. ARCHER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NW MAPLE ST SUITE 210
ISSAQUAH WA
98027-8127
US

IV. Provider business mailing address

29302 NE 16TH PL
CARNATION WA
98014-9644
US

V. Phone/Fax

Practice location:
  • Phone: 206-992-9192
  • Fax: 425-427-2477
Mailing address:
  • Phone: 206-992-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY 60063517
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60063517
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY 60063517
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: