Provider Demographics
NPI:1073536801
Name:BENSON, KURT P (PHD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:P
Last Name:BENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-7001
Mailing Address - Country:US
Mailing Address - Phone:307-675-3349
Mailing Address - Fax:
Practice Address - Street 1:1898 FORT ROAD
Practice Address - Street 2:SHERIDAN VA MEDICAL CENTER
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82807
Practice Address - Country:US
Practice Address - Phone:307-675-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT330103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling