Provider Demographics
NPI:1871084822
Name:BISPHAM PSYCHOTHERAPY INC.
Entity type:Organization
Organization Name:BISPHAM PSYCHOTHERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BISPHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-544-1303
Mailing Address - Street 1:715 N WASHINGTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4256
Mailing Address - Country:US
Mailing Address - Phone:941-404-5557
Mailing Address - Fax:
Practice Address - Street 1:715 N WASHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4256
Practice Address - Country:US
Practice Address - Phone:941-404-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15294101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1XI5POtherBCBS