Basic Information
Provider Information | |||||||||
NPI: | 1558693390 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BISHOP | ||||||||
FirstName: | HARRY | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1217 STONE ST | ||||||||
Address2: |   | ||||||||
City: | JONESBORO | ||||||||
State: | AR | ||||||||
PostalCode: | 724014520 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8709721268 | ||||||||
FaxNumber: | 8709340847 | ||||||||
Practice Location | |||||||||
Address1: | 1217 STONE ST | ||||||||
Address2: |   | ||||||||
City: | JONESBORO | ||||||||
State: | AR | ||||||||
PostalCode: | 724014520 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8709721268 | ||||||||
FaxNumber: | 8709340847 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/04/2010 | ||||||||
LastUpdateDate: | 10/02/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor |   | 103TC0700X | 97-15P | AR | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | 97-15P | AR | N |   | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |   | 103TC2200X | 97-15P | AR | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TB0200X | 97-15P | AR | N |   | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
ID Information
ID | Type | State | Issuer | Description | 172445795 | 05 | AR |   | MEDICAID |