Provider Demographics
NPI:1285265694
Name:BISHOP, RICHARD W JR (MA, LAC, LPC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:BISHOP
Suffix:JR
Gender:M
Credentials:MA, LAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271013
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5017
Mailing Address - Country:US
Mailing Address - Phone:850-572-3178
Mailing Address - Fax:
Practice Address - Street 1:315 W SOUTH BOULDER RD STE 110
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1157
Practice Address - Country:US
Practice Address - Phone:850-572-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001428101YA0400X
COLPC.0016844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACD.0001428OtherCOLORADO STATE LICENSED ADDICTION COUNSELOR
COLPC.0016844OtherCOLORADO STATE LICENSED PROFESSIONAL COUNSELOR