Provider Demographics
NPI:1932617834
Name:BISHOP, AMY MARIE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2020
Mailing Address - Country:US
Mailing Address - Phone:502-572-7930
Mailing Address - Fax:
Practice Address - Street 1:313 N TEJON ST STE 7
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1251
Practice Address - Country:US
Practice Address - Phone:719-822-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-14
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001696106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty