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General NPI Number Information
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NPI Number | 1972625796
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Entity Type | Individual
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Provider Name | GARY H. BISCHOF PHD, LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 724 W CENTRE AVE SUITE 207
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City | PORTAGE
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State | MI
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Zip | 49024-6310
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Country | US
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Telephone | 269-569-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 6346 CYPRESS ST
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City | PORTAGE
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State | MI
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Zip | 49024-2308
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Country | US
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Telephone | 269-321-0270
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Fax | 269-387-5090
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006184
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License Number State | MI
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