Provider Demographics
NPI:1417529330
Name:BENGE, CURTIS (LMSW)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:BENGE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 E ORME ST STE D
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2424
Mailing Address - Country:US
Mailing Address - Phone:316-425-7774
Mailing Address - Fax:316-425-7779
Practice Address - Street 1:8911 E ORME ST STE D
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2424
Practice Address - Country:US
Practice Address - Phone:316-425-7774
Practice Address - Fax:316-425-7779
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS122121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12212OtherKANSAS BEHAVIORAL SCIENCES REGULATORY BOARD