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General NPI Number Information
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NPI Number | 1912444514
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Entity Type | Individual
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Provider Name | TRACIE BISHOP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2017
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1948 N LIMESTONE ST
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City | SPRINGFIELD
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State | OH
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Zip | 45503-2648
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Country | US
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Telephone | 866-534-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 904 N FOUNTAIN AVE
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City | SPRINGFIELD
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State | OH
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Zip | 45504-2226
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.2304748-SUPV
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CS.00001705
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.121005
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License Number State | OH
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