Healthcare Provider Details

I. General information

NPI: 1023178050
Provider Name (Legal Business Name): JAIME BISHOP LSW, LPC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17747 CHILLICOTHE RD SUITE 105
CHAGRIN FALLS OH
44023-4739
US

IV. Provider business mailing address

17747 CHILLICOTHE RD SUITE 105
CHAGRIN FALLS OH
44023-4739
US

V. Phone/Fax

Practice location:
  • Phone: 440-543-8880
  • Fax: 440-543-5911
Mailing address:
  • Phone: 440-543-8880
  • Fax: 440-543-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401013546
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1600033
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0014934
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: