Provider Demographics
NPI:1013636018
Name:BISHOP, KATRINA JO (PLADC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:JO
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17845 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-3104
Mailing Address - Country:US
Mailing Address - Phone:402-660-3225
Mailing Address - Fax:
Practice Address - Street 1:1023 N 205TH ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4642
Practice Address - Country:US
Practice Address - Phone:402-660-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1954101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)