Provider Demographics
NPI:1922352756
Name:DR. MICHAEL BJORNSON
Entity Type:Organization
Organization Name:DR. MICHAEL BJORNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:BJORNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-702-1234
Mailing Address - Street 1:3240 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5322
Mailing Address - Country:US
Mailing Address - Phone:307-702-1234
Mailing Address - Fax:
Practice Address - Street 1:3240 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-5322
Practice Address - Country:US
Practice Address - Phone:307-702-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY465103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY130340600Medicaid