Provider Demographics
NPI:1528387966
Name:BENSON, JON NATHAN (BCBA)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:NATHAN
Last Name:BENSON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-6187
Mailing Address - Country:US
Mailing Address - Phone:334-728-0596
Mailing Address - Fax:
Practice Address - Street 1:2813 BRITTANY LN
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-6187
Practice Address - Country:US
Practice Address - Phone:334-728-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-07-3459103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst