Healthcare Provider Details

I. General information

NPI: 1295236628
Provider Name (Legal Business Name): RAMON BENTON MSW, CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW DIVISION ST STE 120
GRESHAM OR
97030-5293
US

IV. Provider business mailing address

5686 NE 42ND AVE
PORTLAND OR
97218-1410
US

V. Phone/Fax

Practice location:
  • Phone: 503-752-3088
  • Fax:
Mailing address:
  • Phone: 334-552-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: