MEDICARE: ANDREA ELIZABETH BENACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C3909	OR

General Provider Information

NPI Number	:	1376276121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ELIZABETH BENACH

Provider Business Mailing Address
First Line	:	9900 SW GREENBURG RD STE 235
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-5473
Country	:	US
Telephone Number	:	503-308-8016
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 SW GREENBURG RD STE 235
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-5473
Country	:	US
Telephone Number	:	503-308-8016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	08/23/2024

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