Provider Demographics
NPI:1962743641
Name:BISHOP, CARON LEE (PLPC)
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:LEE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:CARON
Other - Middle Name:LEE
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 N BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4313
Mailing Address - Country:US
Mailing Address - Phone:573-334-3486
Mailing Address - Fax:573-334-3524
Practice Address - Street 1:400 WARD AVE REAR
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-1451
Practice Address - Country:US
Practice Address - Phone:573-334-3486
Practice Address - Fax:573-334-3524
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013005536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional