Provider Demographics
NPI:1134796675
Name:TRACY H. BISHOP AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:TRACY H. BISHOP AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:773-548-2260
Mailing Address - Street 1:22750 WOODWARD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1753
Mailing Address - Country:US
Mailing Address - Phone:773-548-2260
Mailing Address - Fax:
Practice Address - Street 1:22750 WOODWARD AVE STE 208
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1753
Practice Address - Country:US
Practice Address - Phone:773-548-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty