Provider Demographics
NPI:1356409585
Name:BING, DOUGLAS (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:BING
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 HIGUERA ST
Mailing Address - Street 2:#200
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3124
Mailing Address - Country:US
Mailing Address - Phone:805-546-0902
Mailing Address - Fax:805-541-3080
Practice Address - Street 1:1264 HIGUERA ST
Practice Address - Street 2:#200
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3124
Practice Address - Country:US
Practice Address - Phone:805-546-0902
Practice Address - Fax:805-541-3080
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist