Provider Demographics
NPI:1477709574
Name:BENSON PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:BENSON PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-297-7540
Mailing Address - Street 1:1308 23RD ST S
Mailing Address - Street 2:SUITE G
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3707
Mailing Address - Country:US
Mailing Address - Phone:701-297-7540
Mailing Address - Fax:
Practice Address - Street 1:1308 23RD ST S
Practice Address - Street 2:SUITE G
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3707
Practice Address - Country:US
Practice Address - Phone:701-297-7540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health