MEDICARE: URSULA JEAN BENWARD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC-12955	AZ

General Provider Information

NPI Number	:	1851566608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	URSULA JEAN BENWARD LPC

Provider Business Mailing Address
First Line	:	13395 N MARANA MAIN ST
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-7008
Country	:	US
Telephone Number	:	480-276-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	12100 N MOUNTAIN CENTRE RD APT 6201
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658-5015
Country	:	US
Telephone Number	:	520-682-4111
Fax Number	:	520-818-3630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	08/08/2012

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