Organization
BISHOPS ENTITIES
Active
Organization
BISHOPS ENTITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LA'SHAWN C PETERSON (SOLE MBR)
(850) 290-2147
Entity
Organization
Contact information
Practice address
2979 SYLVANIA RD, VERNON, FL 32462-3322
(850) 290-2147
Mailing address
2979 SYLVANIA RD, VERNON, FL 32462-3322
(850) 290-2147
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
305R00000X
Preferred Provider Organization
—
—
Other
Enumeration date
07/22/2022
Last updated
07/22/2022
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