Provider Demographics
NPI:1629633375
Name:BENSON, JENNY L (LPC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:BENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:L
Other - Last Name:KEAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 FOREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-9308
Mailing Address - Country:US
Mailing Address - Phone:814-771-5501
Mailing Address - Fax:
Practice Address - Street 1:16 FOREST VIEW DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-9308
Practice Address - Country:US
Practice Address - Phone:814-771-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional