Provider Demographics
NPI:1780954404
Name:BISHOP, KIMBRA LYN (LPC)
Entity type:Individual
Prefix:
First Name:KIMBRA
Middle Name:LYN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23087 STATE HIGHWAY 114
Mailing Address - Street 2:P.O. BOX 232
Mailing Address - City:MEGARGEL
Mailing Address - State:TX
Mailing Address - Zip Code:76370-0232
Mailing Address - Country:US
Mailing Address - Phone:940-562-4351
Mailing Address - Fax:
Practice Address - Street 1:801 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374-1723
Practice Address - Country:US
Practice Address - Phone:940-564-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65637101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional