Provider Demographics
NPI:1568044782
Name:BISHOP, KELLY (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 RITTER RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4828
Mailing Address - Country:US
Mailing Address - Phone:717-357-8230
Mailing Address - Fax:
Practice Address - Street 1:8181 MAIN STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:757-651-3001
Practice Address - Fax:757-222-3833
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13457101YM0800X
PAPC015753P101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty