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Individual

DR. GARY H. BISCHOF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD, LMFT

Contact information

Practice address
724 W CENTRE AVE, SUITE 207, PORTAGE, MI 49024-6310
(269) 569-0404
Mailing address
6346 CYPRESS ST, PORTAGE, MI 49024-2308
(269) 321-0270
(269) 387-5090

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
4101006184
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4101006184
LIC MFT
MI
Enumeration date
04/04/2007
Last updated
07/08/2007
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