Provider Demographics
NPI:1366109365
Name:BISHOP, BROOKE HOWELL (LCSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:HOWELL
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30111 SPYGLASS CIR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1128
Mailing Address - Country:US
Mailing Address - Phone:512-771-0461
Mailing Address - Fax:
Practice Address - Street 1:30111 SPYGLASS CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1128
Practice Address - Country:US
Practice Address - Phone:512-771-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX599731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical