Provider Demographics
NPI:1003119041
Name:BISHOP, DENEASE INEZ (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DENEASE
Middle Name:INEZ
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3539
Mailing Address - Country:US
Mailing Address - Phone:691-278-6790
Mailing Address - Fax:
Practice Address - Street 1:1855 LAKELAND DR
Practice Address - Street 2:SUITE P101
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4913
Practice Address - Country:US
Practice Address - Phone:601-278-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS796101YP2500X
MST0243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist