Provider Demographics
NPI:1639298771
Name:BISHOP, GREGORY G (PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 SW BEVELAND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8682
Mailing Address - Country:US
Mailing Address - Phone:503-670-7410
Mailing Address - Fax:503-670-1066
Practice Address - Street 1:7505 SW BEVELAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8682
Practice Address - Country:US
Practice Address - Phone:503-670-7410
Practice Address - Fax:503-670-1066
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR961103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent