Provider Demographics
NPI:1407032949
Name:BENGTSON, SARAH BETH (MA, LADC, LMFT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:BENGTSON
Suffix:
Gender:F
Credentials:MA, LADC, LMFT
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 7665
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-7665
Mailing Address - Country:US
Mailing Address - Phone:320-309-0936
Mailing Address - Fax:320-259-4048
Practice Address - Street 1:14 7TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4753
Practice Address - Country:US
Practice Address - Phone:320-309-0936
Practice Address - Fax:320-259-4048
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302150101YA0400X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1922409648Medicaid