Healthcare Provider Details

I. General information

NPI: 1124719315
Provider Name (Legal Business Name): ASPEN BENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASPEN ECKERT

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S 2ND AVE STE C
POCATELLO ID
83201-6412
US

IV. Provider business mailing address

155 S 2ND AVE STE C
POCATELLO ID
83201-6412
US

V. Phone/Fax

Practice location:
  • Phone: 208-784-7910
  • Fax:
Mailing address:
  • Phone: 208-784-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-9552
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-9552
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-9552
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: