Healthcare Provider Details

I. General information

NPI: 1891168076
Provider Name (Legal Business Name): MELISSA BISHOP LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

IV. Provider business mailing address

1130 BONNIE LN
MAYFIELD HEIGHTS OH
44124-1874
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-3568
  • Fax: 440-285-2207
Mailing address:
  • Phone: 330-990-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.19011483
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: