Healthcare Provider Details

I. General information

NPI: 1295402642
Provider Name (Legal Business Name): AMBER LYNN BISHOP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER L VANDENACK LPCA,

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 431
EUGENE OR
97401-3158
US

IV. Provider business mailing address

744 NW 4TH ST
PRINEVILLE OR
97754-1436
US

V. Phone/Fax

Practice location:
  • Phone: 541-390-4559
  • Fax:
Mailing address:
  • Phone: 458-260-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC9859
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: