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General NPI Number Information
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NPI Number | 1609419860
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Entity Type | Individual
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Provider Name | MELISSA AIMEE BENSON
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Gender | Female
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 3125 MYERS ST
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City | RIVERSIDE
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State | CA
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Zip | 92503-5527
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Country | US
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Telephone | 951-358-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 52425 AVENIDA MARTINEZ
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City | LA QUINTA
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State | CA
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Zip | 92253-3269
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Country | US
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Telephone | 818-264-6599
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 107654
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License Number State | CA
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