Healthcare Provider Details

I. General information

NPI: 1073536801
Provider Name (Legal Business Name): KURT P BENSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1898 FORT ROAD SHERIDAN VA MEDICAL CENTER
SHERIDAN WY
82807
US

IV. Provider business mailing address

PO BOX 7001
SHERIDAN WY
82801-7001
US

V. Phone/Fax

Practice location:
  • Phone: 307-675-3349
  • Fax:
Mailing address:
  • Phone: 307-675-3349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number330
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: