Provider Demographics
NPI:1821131426
Name:BENSON, CHARLES HAMILTON SR (MFT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HAMILTON
Last Name:BENSON
Suffix:SR
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-8828
Mailing Address - Country:US
Mailing Address - Phone:530-822-7200
Mailing Address - Fax:
Practice Address - Street 1:200 BEATTY STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-414-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist