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General NPI Number Information
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NPI Number | 1124757182
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Entity Type | Individual
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Provider Name | KATIE PETERSON-BENSON MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 2422 BURTON ST SE STE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4810
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Country | US
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Telephone | 616-226-6522
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Fax | 616-608-6751
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Provider Business Mailing Address
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Address Line | 115 PADDOCK AVE SE APT 2
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1570
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401225342
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License Number State | MI
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