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General NPI Number Information
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NPI Number | 1093679904
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Entity Type | Individual
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Provider Name | MR. BENJAMIN LUNDQUIST
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Gender | Male
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 115 SUNSET ST
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City | ELK CITY
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State | OK
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Zip | 73644-1629
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Country | US
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Telephone | 801-860-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 115 SUNSET ST
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City | ELK CITY
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State | OK
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Zip | 73644-1629
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Country | US
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Telephone | 801-860-7774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 21997
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License Number State | OK
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