Healthcare Provider Details

I. General information

NPI: 1528981941
Provider Name (Legal Business Name): KELLEY BENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 COURT ST STE B
MUSKOGEE OK
74401-6303
US

IV. Provider business mailing address

1247 ROBIN LN # 124U
FORT GIBSON OK
74434-1003
US

V. Phone/Fax

Practice location:
  • Phone: 918-310-0000
  • Fax:
Mailing address:
  • Phone: 580-320-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: