Provider Demographics
NPI:1629754924
Name:BENSON, PETER COLEMAN
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:COLEMAN
Last Name:BENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 S BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-1518
Mailing Address - Country:US
Mailing Address - Phone:772-321-6632
Mailing Address - Fax:
Practice Address - Street 1:2919 S BANNOCK ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-1518
Practice Address - Country:US
Practice Address - Phone:772-321-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health