Provider Demographics
NPI:1790316347
Name:DR. DANIEL BISHOP
Entity Type:Organization
Organization Name:DR. DANIEL BISHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-374-3444
Mailing Address - Street 1:415 BROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1800
Mailing Address - Country:US
Mailing Address - Phone:262-374-3444
Mailing Address - Fax:
Practice Address - Street 1:415 BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1800
Practice Address - Country:US
Practice Address - Phone:262-374-3444
Practice Address - Fax:844-247-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty