Provider Demographics
NPI:1558693390
Name:BISHOP, HARRY D (PSYD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:D
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 STONE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4520
Mailing Address - Country:US
Mailing Address - Phone:870-972-1268
Mailing Address - Fax:870-934-0847
Practice Address - Street 1:1217 STONE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4520
Practice Address - Country:US
Practice Address - Phone:870-972-1268
Practice Address - Fax:870-934-0847
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AR97-15P103TC0700X, 103G00000X, 103TC2200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172445795Medicaid