MEDICARE: MICHELLE OLIVIA BENZ LPC

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	101YM0800X	Mental Health Counselor	C.2607891	OH
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1457821282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE OLIVIA BENZ LPC

Provider Business Mailing Address
First Line	:	101 HARTSHORN DR
Second Line	:
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-2603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 MAIN ST
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-1538
Country	:	US
Telephone Number	:	440-214-9062
Fax Number	:

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

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	03/13/2026

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