Provider Demographics
NPI:1407936255
Name:BISHOP, PAULINE ANNE (MFT)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:ANNE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93457-2723
Mailing Address - Country:US
Mailing Address - Phone:805-937-7575
Mailing Address - Fax:805-934-6667
Practice Address - Street 1:301 EAST COOK STREET SUITE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5133
Practice Address - Country:US
Practice Address - Phone:805-937-7575
Practice Address - Fax:805-934-6667
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist