Provider Demographics
NPI:1184926107
Name:BISHOP, IMELDA (PSYCHOTHERAPIST)
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:IMELDA
Other - Middle Name:
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CACII
Mailing Address - Street 1:1443 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1932
Mailing Address - Country:US
Mailing Address - Phone:719-213-0482
Mailing Address - Fax:
Practice Address - Street 1:509 E 13TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2940
Practice Address - Country:US
Practice Address - Phone:719-546-6666
Practice Address - Fax:719-543-7764
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)