Provider Demographics
NPI:1952791196
Name:BISHOP, LISA (LPCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GAYNESS-BISHOP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:571 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4132
Mailing Address - Country:US
Mailing Address - Phone:614-547-2166
Mailing Address - Fax:
Practice Address - Street 1:571 HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4132
Practice Address - Country:US
Practice Address - Phone:614-547-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1100284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional