Provider Demographics
NPI:1285227520
Name:BLANFORD, BENJAMIN (BHA)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:BLANFORD
Suffix:
Gender:M
Credentials:BHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9523
Mailing Address - Country:US
Mailing Address - Phone:502-807-0108
Mailing Address - Fax:
Practice Address - Street 1:3260 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7808
Practice Address - Country:US
Practice Address - Phone:907-796-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst