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General NPI Number Information
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NPI Number | 1871084822
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Entity Type | Organization
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Legal Business Name | BISPHAM PSYCHOTHERAPY INC.
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 715 N WASHINGTON BLVD STE A
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City | SARASOTA
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State | FL
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Zip | 34236-4256
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Country | US
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Telephone | 941-404-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 715 N WASHINGTON BLVD STE A
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City | SARASOTA
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State | FL
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Zip | 34236-4256
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Country | US
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Telephone | 941-404-5557
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAUNA BISPHAM
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Credential | LMHC
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Telephone | 941-544-1303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH15294
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License Number State | FL
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