Provider Demographics
NPI:1548732605
Name:BISHOP, LAUREN M (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:M
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9784
Mailing Address - Country:US
Mailing Address - Phone:530-209-4920
Mailing Address - Fax:530-688-7729
Practice Address - Street 1:4905 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9784
Practice Address - Country:US
Practice Address - Phone:530-209-4920
Practice Address - Fax:530-688-7729
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-23936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst