Provider Demographics
NPI:1114589447
Name:BISHOP, ELIZABETH N
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-9677
Mailing Address - Country:US
Mailing Address - Phone:740-624-3674
Mailing Address - Fax:
Practice Address - Street 1:1 HALLORAN DRIVE
Practice Address - Street 2:
Practice Address - City:ST. CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-296-5743
Practice Address - Fax:740-296-5952
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-09-25
Deactivation Date:2019-08-15
Deactivation Code:
Reactivation Date:2019-09-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician