Healthcare Provider Details

I. General information

NPI: 1063352813
Provider Name (Legal Business Name): DEKLYN DEAN BISHOP SUDRC 1 #24374
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 TWIN VIEW BLVD
REDDING CA
96003-2046
US

IV. Provider business mailing address

915 TWIN VIEW BLVD
REDDING CA
96003-2046
US

V. Phone/Fax

Practice location:
  • Phone: 530-201-1410
  • Fax: 530-349-8584
Mailing address:
  • Phone: 530-201-1410
  • Fax: 530-349-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: