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General NPI Number Information
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NPI Number | 1205003555
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Entity Type | Individual
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Provider Name | JEREMY K BISHOP
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Gender | Male
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 110 SOUTH COLLEGE AVE
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City | OXFORD
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State | OH
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Zip | 45056-1738
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Country | US
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Telephone | 513-523-4149
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 NW WASHINGTON BLVD
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City | HAMILTON
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State | OH
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Zip | 45013-1753
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Country | US
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Telephone | 513-255-2903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.0501192
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | OH
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