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General NPI Number Information
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NPI Number | 1922352756
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Entity Type | Organization
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Legal Business Name | DR. MICHAEL BJORNSON
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 3240 S POPLAR ST
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City | CASPER
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State | WY
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Zip | 82601-5322
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Country | US
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Telephone | 307-702-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 3240 S POPLAR ST
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City | CASPER
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State | WY
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Zip | 82601-5322
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Country | US
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Telephone | 307-702-1234
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. MICHAEL JONATHAN BJORNSON
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Credential | PH.D.
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Telephone | 307-702-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 465
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License Number State | WY
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