Provider Demographics
NPI:1508243445
Name:BISHOP, JENNIFER MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7504
Mailing Address - Country:US
Mailing Address - Phone:214-455-0928
Mailing Address - Fax:
Practice Address - Street 1:17480 DALLAS PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7337
Practice Address - Country:US
Practice Address - Phone:214-455-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical