| Doctor Name: | C JEFFREY BISE |
| NPI Number: | 1497831432 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | |
| Business Practice Address: | 409 Glenwood St., Ste 500 Glen Rose, TX - 76043 |
| Business Phone Number: | 2548972202 |
| Business Fax Number: | 2548972102 |
| Mailing Address: | Po Box 806, GLEN ROSE |
| State: | TX |
| Postal Code: | 760430806 |
| Phone Number: | 2548972202 |
| Fax Number: | 2548972102 |
| NPI Enumeration Date: | 10/31/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |