Provider Demographics
NPI:1366645095
Name:BACHMAN-MORAN, MARY MARGARET (MA,LLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:BACHMAN-MORAN
Suffix:
Gender:F
Credentials:MA,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 S M 66
Mailing Address - Street 2:
Mailing Address - City:EAST JORDAN
Mailing Address - State:MI
Mailing Address - Zip Code:49727-9169
Mailing Address - Country:US
Mailing Address - Phone:231-631-8856
Mailing Address - Fax:
Practice Address - Street 1:800 LIVINGSTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8351
Practice Address - Country:US
Practice Address - Phone:989-732-6292
Practice Address - Fax:989-732-0780
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003298103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist