Provider Demographics
NPI:1831565829
Name:BISHER, MALLORY (ARNP, PMHNP-BC, LMHC)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:BISHER
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC, LMHC
Other - Prefix:MS
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:ANDREASSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:12035 UNIVERSITY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8264
Mailing Address - Country:US
Mailing Address - Phone:515-639-0034
Mailing Address - Fax:515-789-3476
Practice Address - Street 1:12035 UNIVERSITY AVE STE 202
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8264
Practice Address - Country:US
Practice Address - Phone:515-639-0034
Practice Address - Fax:515-789-3476
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092680101YM0800X
MNCC01021101YP2500X
IAG181636363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional