Healthcare Provider Details

I. General information

NPI: 1306266564
Provider Name (Legal Business Name): BENJAMIN THOMAS MUNSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W B ST STE B
SPRINGFIELD OR
97477-4575
US

IV. Provider business mailing address

755 HORN LN
EUGENE OR
97404-2978
US

V. Phone/Fax

Practice location:
  • Phone: 541-628-0903
  • Fax: 541-628-0943
Mailing address:
  • Phone: 541-625-0903
  • Fax: 541-625-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: