Provider Demographics
NPI:1437272853
Name:BISHOP, TARA ANDERSON (LCPC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ANDERSON
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 1:617 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4522
Mailing Address - Country:US
Mailing Address - Phone:406-581-3774
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4773
Practice Address - Country:US
Practice Address - Phone:406-581-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC 1161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health