Individual
KELLY L BISHOP-DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2285 STAR S AVE, GRAND FORKS, ND 58201-3478
(701) 330-8210
(701) 330-8210
Mailing address
2285 STAR S AVE, GRAND FORKS, ND 58201-3478
(701) 330-8210
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
2616
TN
103TC0700X
Clinical Psychologist
Primary
513
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4107555
BCBS TN
TN
Enumeration date
12/13/2006
Last updated
09/03/2015
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