MEDICARE: JILL C BISHOP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1457292005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JILL C BISHOP LLC

Provider Business Mailing Address
First Line	:	10315 GLEN ARBOR PASS
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9539
Country	:	US
Telephone Number	:	260-229-7356
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1547
Country	:	US
Telephone Number	:	260-200-3916
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JILL BISHOP
Credential	:	LMHC
Telephone Number	:	260-229-7356

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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