Healthcare Provider Details

I. General information

NPI: 1063737179
Provider Name (Legal Business Name): MICHELE BISHOP PH.D., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N 48TH ST
PHOENIX AZ
85008-7723
US

IV. Provider business mailing address

19019 VENTURA BLVD
TARZANA CA
91356-3253
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-2345
  • Fax: 866-587-2383
Mailing address:
  • Phone: 818-345-2345
  • Fax: 866-587-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: