Healthcare Provider Details

I. General information

NPI: 1811836810
Provider Name (Legal Business Name): JOELLE J BISHOP MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 ROGERS DR STE 100
ROGERS MN
55374-4721
US

IV. Provider business mailing address

21000 ROGERS DR STE 100
ROGERS MN
55374-4721
US

V. Phone/Fax

Practice location:
  • Phone: 763-291-5505
  • Fax:
Mailing address:
  • Phone: 763-291-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5419
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: