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General NPI Number Information
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NPI Number | 1770760720
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Entity Type | Individual
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Provider Name | MR. KEVIN LEE BENBOW
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Gender | Male
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 202 S 1ST AVE STE 104
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City | YUMA
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State | AZ
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Zip | 85364-2366
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Country | US
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Telephone | 928-750-1774
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Fax | 928-783-1065
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Provider Business Mailing Address
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Address Line | 202 S 1ST AVE STE 104
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City | YUMA
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State | AZ
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Zip | 85364-2366
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Country | US
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Telephone | 928-750-1774
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Fax | 928-783-1065
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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 | LPC 13276
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License Number State | AZ
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