Individual
DR. KELLI M BISHOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
111 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 523-1130
Mailing address
4255 WADE GREEN RD NW, STE 414, KENNESAW, GA 30144-1763
(678) 213-2194
(678) 922-7767
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-202640
ID
Other
Enumeration date
03/30/2007
Last updated
07/25/2016
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