Provider Demographics
NPI:1841851318
Name:BISHOP, NICOLE ALANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ALANA
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BROMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1882
Mailing Address - Country:US
Mailing Address - Phone:248-379-5033
Mailing Address - Fax:
Practice Address - Street 1:701 W BROMPTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1882
Practice Address - Country:US
Practice Address - Phone:248-379-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010009103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist