Healthcare Provider Details

I. General information

NPI: 1881418440
Provider Name (Legal Business Name): MATT BISHOP MARRIAGE & FAMILY THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2456 BROADWAY
SAN DIEGO CA
92102-2022
US

IV. Provider business mailing address

2456 BROADWAY
SAN DIEGO CA
92102-2022
US

V. Phone/Fax

Practice location:
  • Phone: 858-750-0213
  • Fax:
Mailing address:
  • Phone: 858-208-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW BISHOP
Title or Position: OWNER
Credential: LMFT
Phone: 858-208-0131