Provider Demographics
NPI:1578630554
Name:BENSON, KRISTIANA ELLEN (MA, LMFT, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIANA
Middle Name:ELLEN
Last Name:BENSON
Suffix:
Gender:F
Credentials:MA, LMFT, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 S TENNIS LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2256
Mailing Address - Country:US
Mailing Address - Phone:605-307-9910
Mailing Address - Fax:605-362-5601
Practice Address - Street 1:4410 S TENNIS LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2256
Practice Address - Country:US
Practice Address - Phone:605-307-9910
Practice Address - Fax:605-362-5601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT1649106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist