Healthcare Provider Details

I. General information

NPI: 1184378077
Provider Name (Legal Business Name): JENNIFER MURDOCK BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 KATE CAMERON DR
CHEYENNE WY
82009-7403
US

IV. Provider business mailing address

1324 KATE CAMERON DR
CHEYENNE WY
82009-7403
US

V. Phone/Fax

Practice location:
  • Phone: 970-518-2521
  • Fax:
Mailing address:
  • Phone: 970-518-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1695
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0005486
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1695
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: