Provider Demographics
NPI:1871003566
Name:BISHOP, TYLER E (LSW)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:E
Last Name:BISHOP
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3151 COUNTY ROAD 2425
Practice Address - Street 2:
Practice Address - City:STRYKER
Practice Address - State:OH
Practice Address - Zip Code:43557-9418
Practice Address - Country:US
Practice Address - Phone:419-428-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS1451341OtherLICENSE