Healthcare Provider Details

I. General information

NPI: 1891937272
Provider Name (Legal Business Name): LAWRENCE P BISCHOFF III LCPC, LMHC-A (WA)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 1ST AVE W
KALISPELL MT
59901-5607
US

IV. Provider business mailing address

1035 1ST AVE W
KALISPELL MT
59901-5607
US

V. Phone/Fax

Practice location:
  • Phone: 406-751-8113
  • Fax: 406-751-8148
Mailing address:
  • Phone: 406-751-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-4700
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: