Provider Demographics
NPI:1427176114
Name:BISHOP, TRACY HILLARY (MSW)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:HILLARY
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 WOODWARD AVE
Mailing Address - Street 2:LOFT 903
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-2025
Mailing Address - Country:US
Mailing Address - Phone:313-477-3538
Mailing Address - Fax:313-921-8102
Practice Address - Street 1:5555 CONNER ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3448
Practice Address - Country:US
Practice Address - Phone:313-921-8102
Practice Address - Fax:313-921-8102
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8010835631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical