Healthcare Provider Details

I. General information

NPI: 1700450863
Provider Name (Legal Business Name): LAUREL DIANE BENSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 TESCONI CIR STE B
SANTA ROSA CA
95401-4691
US

IV. Provider business mailing address

480 TESCONI CIR STE B
SANTA ROSA CA
95401-4691
US

V. Phone/Fax

Practice location:
  • Phone: 707-206-7268
  • Fax: 707-206-7254
Mailing address:
  • Phone: 707-206-7268
  • Fax: 707-206-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144843
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAMFT294733
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number188910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: