Provider Demographics
NPI:1760618839
Name:BISSON, RICHARD J (MDIV,MA, MFC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:BISSON
Suffix:
Gender:M
Credentials:MDIV,MA, MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27393 YNEZ RD STE 264
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4610
Mailing Address - Country:US
Mailing Address - Phone:951-695-3337
Mailing Address - Fax:
Practice Address - Street 1:27393 YNEZ RD
Practice Address - Street 2:SUITE 151
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5604
Practice Address - Country:US
Practice Address - Phone:951-695-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist