Provider Demographics
NPI:1184827073
Name:BISHOP, ALLEN EAMES (PHD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:EAMES
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MESA ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTECITO
Mailing Address - State:CA
Mailing Address - Zip Code:93108
Mailing Address - Country:US
Mailing Address - Phone:805-969-0037
Mailing Address - Fax:
Practice Address - Street 1:1100 MESA RD
Practice Address - Street 2:
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2433
Practice Address - Country:US
Practice Address - Phone:805-969-0037
Practice Address - Fax:805-565-1932
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP8492102L00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8492Medicare ID - Type UnspecifiedPSYCHOLOGIST