Provider Demographics
NPI:1295402642
Name:BISHOP, AMBER LYNN (CADC-1, LPC-A)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:CADC-1, LPC-A
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:VANDENACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC - R
Mailing Address - Street 1:744 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1436
Mailing Address - Country:US
Mailing Address - Phone:541-527-6532
Mailing Address - Fax:
Practice Address - Street 1:1655 SW HIGHLAND AVE STE 3
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2558
Practice Address - Country:US
Practice Address - Phone:541-923-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-21-798101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)