Provider Demographics
NPI:1740163096
Name:BISHOV, CHASE (AMFT)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:BISHOV
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 BODEGA AVE # B
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3657
Mailing Address - Country:US
Mailing Address - Phone:310-713-0799
Mailing Address - Fax:
Practice Address - Street 1:76 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4179
Practice Address - Country:US
Practice Address - Phone:831-331-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health