MEDICARE: DR. MICHAEL ANGELO BORDERS PSY.D., ABPP, FAACP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0004X	Health Psychologist	3861	AZ
2	103TE1100X	Exercise & Sports Psychologist	3861	AZ
3	103TR0400X	Rehabilitation Psychologist	3861	AZ
4	103G00000X	Clinical Neuropsychologist	3861	AZ
5	103TA0400X	Addiction (Substance Use Disorder) Psychologist	0810002999	VA
6	103TA0700X	Adult Development & Aging Psychologist	0810002999	VA
7	103TC0700X	Clinical Psychologist	0810002999	VA
8	103TF0000X	Family Psychologist	0810002999	VA
9	103TF0200X	Forensic Psychologist	0810002999	VA
10	103TH0100X	Health Service Psychologist	0810002999	VA
11	103TH0100X	Health Service Psychologist	3861	AZ
12	103TP2701X	Group Psychotherapy Psychologist	0810002999	VA
13	103TR0400X	Rehabilitation Psychologist	0810002999	VA
14	171000000X	Military Health Care Provider	3861	AZ
15	171W00000X	Contractor	3861	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302	OTHER		AMERICAN BOARD OF PROFESS
2	44572	OTHER		NATIONAL REGISTER OF HEAL
3	8264	OTHER		AMERICAN COLLEGE OF FOREN
4	3861	OTHER	AZ	CLINICAL PSYCHOLOGY
5	0810002999	OTHER	VA	CLINICAL PSYCHOLOGY

General Provider Information

NPI Number	:	1275696924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANGELO BORDERS PSY.D., ABPP, FAACP

Provider Business Mailing Address
First Line	:	3300 N MESQUITE RD
Second Line	:
City	:	COCHISE
State	:	AZ
Zip	:	85606-8729
Country	:	US
Telephone Number	:	520-826-0299
Fax Number	:	520-826-0300

Provider Business Practice Location Address
First Line	:	3300 N MESQUITE RD
Second Line	:
City	:	COCHISE
State	:	AZ
Zip	:	85606-8729
Country	:	US
Telephone Number	:	520-826-0299
Fax Number	:	520-826-0300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	12/31/2008

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