Provider Demographics
NPI:1043569874
Name:BENHAM, BROOKE N (LPC; LMHC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:N
Last Name:BENHAM
Suffix:
Gender:F
Credentials:LPC; LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10161 SUTTON DR #4
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322
Mailing Address - Country:US
Mailing Address - Phone:515-267-1340
Mailing Address - Fax:515-267-1355
Practice Address - Street 1:1200 VALLEY WEST DRIVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-267-1340
Practice Address - Fax:515-267-1355
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080528101YM0800X
MO2012024652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional