Provider Demographics
NPI:1275696924
Name:BORDERS, MICHAEL ANGELO (PSYD, ABPP, FAACP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:BORDERS
Suffix:
Gender:M
Credentials:PSYD, ABPP, FAACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N MESQUITE RD
Mailing Address - Street 2:
Mailing Address - City:COCHISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85606-8729
Mailing Address - Country:US
Mailing Address - Phone:520-826-0299
Mailing Address - Fax:520-826-0300
Practice Address - Street 1:3300 N MESQUITE RD
Practice Address - Street 2:
Practice Address - City:COCHISE
Practice Address - State:AZ
Practice Address - Zip Code:85606-8729
Practice Address - Country:US
Practice Address - Phone:520-826-0299
Practice Address - Fax:520-826-0300
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3861103TH0004X, 103TE1100X, 103TR0400X, 103G00000X, 103TH0100X, 171000000X, 171W00000X
VA0810002999103TA0400X, 103TA0700X, 103TC0700X, 103TF0000X, 103TF0200X, 103TH0100X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No171000000XOther Service ProvidersMilitary Health Care Provider
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5302OtherAMERICAN BOARD OF PROFESS
44572OtherNATIONAL REGISTER OF HEAL
8264OtherAMERICAN COLLEGE OF FOREN
AZ3861OtherCLINICAL PSYCHOLOGY
VA0810002999OtherCLINICAL PSYCHOLOGY