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NPI Code Detail

MEDICARE: GRACIE FAYE BISHOP LMFT

MEDICARE: GRACIE FAYE BISHOP LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2390200000XStudent in an Organized Health Care Education/Training Program
3106H00000XMarriage & Family Therapist134941CA

General Provider Information

NPI Number : 1396096111
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACIE FAYE BISHOP LMFT
Provider Business Mailing Address
First Line : 9713 SANTA MONICA BLVD STE 201
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90210-4236
Country : US
Telephone Number : 818-921-2641
Fax Number :
Provider Business Practice Location Address
First Line : 9713 SANTA MONICA BLVD STE 201
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90210-4236
Country : US
Telephone Number : 310-564-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2012
Last Update Date : 01/08/2024

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Directions to “ GRACIE FAYE BISHOP LMFT” Practice Location

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