Healthcare Provider Details

I. General information

NPI: 1215039201
Provider Name (Legal Business Name): DANIEL WAYNE BISHOP PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S 7TH ST STOP 2
DELAVAN WI
53115-1964
US

IV. Provider business mailing address

191 W SOUTH ST
LAKE GENEVA WI
53147-2417
US

V. Phone/Fax

Practice location:
  • Phone: 262-374-4444
  • Fax: 844-247-2735
Mailing address:
  • Phone: 262-374-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15360-135
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15348-132
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4047-125
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14303
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number180004694
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number320657
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: