Provider Demographics
NPI:1760745020
Name:PAZ, BENJAMIN (LPC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PAZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 GATEWAY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-6035
Mailing Address - Country:US
Mailing Address - Phone:503-325-4584
Mailing Address - Fax:503-741-3089
Practice Address - Street 1:422 GATEWAY AVE STE 210
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6035
Practice Address - Country:US
Practice Address - Phone:503-325-4584
Practice Address - Fax:503-741-3089
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2860101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health