Provider Demographics
NPI:1356626998
Name:BENSON, BONNIE KAY (LPC-922)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:KAY
Last Name:BENSON
Suffix:
Gender:F
Credentials:LPC-922
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W IOWA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2826
Mailing Address - Country:US
Mailing Address - Phone:208-546-9322
Mailing Address - Fax:208-475-9888
Practice Address - Street 1:430 W IOWA AVE STE B
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2826
Practice Address - Country:US
Practice Address - Phone:208-546-9332
Practice Address - Fax:208-475-9888
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-922101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional