Healthcare Provider Details

I. General information

NPI: 1356626998
Provider Name (Legal Business Name): BONNIE KAY BENSON LPC-922
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W IOWA AVE STE B
NAMPA ID
83686-2826
US

IV. Provider business mailing address

430 W IOWA AVE STE B
NAMPA ID
83686-2826
US

V. Phone/Fax

Practice location:
  • Phone: 208-546-9332
  • Fax: 208-475-9888
Mailing address:
  • Phone: 208-546-9322
  • Fax: 208-475-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-922
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-922
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: