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General NPI Number Information
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NPI Number | 1780954404
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Entity Type | Individual
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Provider Name | KIMBRA LYN BISHOP LPC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 801 W HAMILTON ST
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City | OLNEY
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State | TX
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Zip | 76374-1723
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Country | US
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Telephone | 940-564-8625
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Fax |
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Provider Business Mailing Address
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Address Line | 23087 STATE HIGHWAY 114 P.O. BOX 232
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City | MEGARGEL
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State | TX
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Zip | 76370-0232
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Country | US
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Telephone | 940-562-4351
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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 | 65637
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License Number State | TX
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