Provider Demographics
NPI:1114509940
Name:MESSENGER, BENJAMIN RAY
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RAY
Last Name:MESSENGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-3034
Mailing Address - Country:US
Mailing Address - Phone:505-493-8998
Mailing Address - Fax:
Practice Address - Street 1:6100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-3034
Practice Address - Country:US
Practice Address - Phone:505-326-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health