Basic Information
Provider Information
NPI: 1003149576
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BACHOP
FirstName: MICHAEL
MiddleName: J.
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1195 W 27TH PL
Address2:  
City: EUGENE
State: OR
PostalCode: 974052238
CountryCode: US
TelephoneNumber: 6602022407
FaxNumber:  
Practice Location
Address1: 3521 NW SAMARITAN DR STE 201
Address2:  
City: CORVALLIS
State: OR
PostalCode: 973304744
CountryCode: US
TelephoneNumber: 6602022407
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/15/2009
LastUpdateDate: 01/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X2009026784MON Behavioral Health & Social Service ProvidersPsychologist 
103TA0400X2009026784MON Behavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
103TA0700X2009026784MON Behavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
103TB0200X2009026784MON Behavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
103TC0700X2009026784MOY Behavioral Health & Social Service ProvidersPsychologistClinical
103TC1900X2009026784MON Behavioral Health & Social Service ProvidersPsychologistCounseling
103TC2200X2009026784MON Behavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
103TF0200X2009026784MON Behavioral Health & Social Service ProvidersPsychologistForensic
103TP2701X2009026784MON Behavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy

No ID Information.


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