Provider Demographics
NPI:1093328346
Name:BISHOP, KATHRYN GLOVER
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:GLOVER
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 E 97TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5011
Mailing Address - Country:US
Mailing Address - Phone:918-852-5220
Mailing Address - Fax:866-648-9795
Practice Address - Street 1:5921 E 97TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-5011
Practice Address - Country:US
Practice Address - Phone:918-852-5220
Practice Address - Fax:866-648-9795
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty