Provider Demographics
NPI:1699523159
Name:BISHOP, LORI BETH (LCSW, PMH-C)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:BISHOP
Suffix:
Gender:
Credentials:LCSW, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 W KOENIG LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1207
Mailing Address - Country:US
Mailing Address - Phone:512-222-9874
Mailing Address - Fax:
Practice Address - Street 1:1704 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1207
Practice Address - Country:US
Practice Address - Phone:512-222-9874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical