Provider Demographics
NPI:1366643181
Name:BENSON, ELIZABETH (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:LMFT, LPCC
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 276
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-0276
Mailing Address - Country:US
Mailing Address - Phone:707-357-5524
Mailing Address - Fax:
Practice Address - Street 1:4105 KACHEMAK WAY
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7164
Practice Address - Country:US
Practice Address - Phone:707-357-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAMFC 48672106H00000X
CALPC 171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC12456218OtherCAQH