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General NPI Number Information
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NPI Number | 1801284039
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Entity Type | Individual
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Provider Name | PETER BENSON MA, LMFTA
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Gender | Male
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 13552 S 110 W SUITE 204
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City | DRAPER
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State | UT
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Zip | 84020-2401
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Country | US
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Telephone | 801-999-0580
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Fax |
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Provider Business Mailing Address
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Address Line | 542 W 1600 S
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City | OREM
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State | UT
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Zip | 84058-7320
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Country | US
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Telephone | 208-390-4435
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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 |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 9679668-3904
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License Number State | UT
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