Healthcare Provider Details

I. General information

NPI: 1407072291
Provider Name (Legal Business Name): STACIE BENSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W 92ND AVE SUITE 100C
FEDERAL HEIGHTS CO
80260-5221
US

IV. Provider business mailing address

9250 GARRISON ST
WESTMINSTER CO
80021-4333
US

V. Phone/Fax

Practice location:
  • Phone: 303-941-5161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3907
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: