Provider Demographics
NPI:1316717903
Name:BISHOP, BENJAMIN LOGAN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LOGAN
Last Name:BISHOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 SHELL POINT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6847
Mailing Address - Country:US
Mailing Address - Phone:843-592-9364
Mailing Address - Fax:813-645-2007
Practice Address - Street 1:BEAUFORT MIDDLE SCHOOL
Practice Address - Street 2:2501 MOSSY OAKS ROAD
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-322-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician