Provider Demographics
NPI:1700614443
Name:BISHOP, TIMOTHY RANDALL (PCSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RANDALL
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 STRAHAN PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9162
Mailing Address - Country:US
Mailing Address - Phone:307-672-2624
Mailing Address - Fax:
Practice Address - Street 1:3322 STRAHAN PKWY
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-9162
Practice Address - Country:US
Practice Address - Phone:307-672-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-11761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty