Healthcare Provider Details

I. General information

NPI: 1558809129
Provider Name (Legal Business Name): BISHOP CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W GRAY ST
NORMAN OK
73069-7117
US

IV. Provider business mailing address

3280 MARSHALL AVE
NORMAN OK
73072-8022
US

V. Phone/Fax

Practice location:
  • Phone: 408-329-7300
  • Fax: 405-364-5379
Mailing address:
  • Phone: 405-579-5858
  • Fax: 405-292-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number489
License Number StateOK

VIII. Authorized Official

Name: WILLIAM F SCHMID
Title or Position: MANAGING MEMBER
Credential: PHD
Phone: 405-641-1920