Healthcare Provider Details

I. General information

NPI: 1023425618
Provider Name (Legal Business Name): SCOTT ERIC BISCHOFF PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 N BRIARWOOD LANE SUITE A
MUNCIE IN
47304-5337
US

IV. Provider business mailing address

3645 N BRIARWOOD LANE SUITE A
MUNCIE IN
47304-5337
US

V. Phone/Fax

Practice location:
  • Phone: 765-289-5520
  • Fax: 765-289-5840
Mailing address:
  • Phone: 765-289-5520
  • Fax: 765-289-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001528A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number39001528A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: