Provider Demographics
NPI:1063526754
Name:BISHOP, JOHN K (LPC LICENSED PROFESS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:BISHOP
Suffix:
Gender:M
Credentials:LPC LICENSED PROFESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16226 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8300
Mailing Address - Country:US
Mailing Address - Phone:208-602-4680
Mailing Address - Fax:208-454-9770
Practice Address - Street 1:16226 HORIZON DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-8300
Practice Address - Country:US
Practice Address - Phone:208-602-4680
Practice Address - Fax:208-454-9770
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC1468101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional