Provider Demographics
NPI:1184650129
Name:BISHOP, NILDA SOTO (LCPC)
Entity Type:Individual
Prefix:MS
First Name:NILDA
Middle Name:SOTO
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 BEAR CREEK TRL RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875
Mailing Address - Country:US
Mailing Address - Phone:406-642-3522
Mailing Address - Fax:406-642-9768
Practice Address - Street 1:109 N 4TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2401
Practice Address - Country:US
Practice Address - Phone:406-363-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT743300OtherBLUE CROSS BLUE SHIELD
MT0257210Medicaid