Provider Demographics
NPI:1063556009
Name:BISHOP, EVANGELINE (PSYD)
Entity type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:EVANGELINE
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4206 W 58TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-3406
Mailing Address - Country:US
Mailing Address - Phone:562-881-9726
Mailing Address - Fax:
Practice Address - Street 1:2716 OCEAN PARK BLVD STE 1055
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5231
Practice Address - Country:US
Practice Address - Phone:424-406-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25157103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist