Provider Demographics
NPI:1578047379
Name:BISHOP, CAMILLE (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7029 SE TAGGART ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1144
Mailing Address - Country:US
Mailing Address - Phone:831-238-5761
Mailing Address - Fax:
Practice Address - Street 1:7504 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5841
Practice Address - Country:US
Practice Address - Phone:831-238-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health