Provider Demographics
NPI:1952458606
Name:BISHOP, RILEY JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RILEY
Middle Name:JAMES
Last Name:BISHOP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BROADWAY ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111
Mailing Address - Country:US
Mailing Address - Phone:816-756-0684
Mailing Address - Fax:816-756-0604
Practice Address - Street 1:4400 BROADWAY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111
Practice Address - Country:US
Practice Address - Phone:816-756-0684
Practice Address - Fax:816-756-0604
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0029671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494714009Medicaid
F527465Medicare ID - Type Unspecified
MO494714009Medicaid