Provider Demographics
NPI:1851566608
Name:BENWARD, URSULA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:JEAN
Last Name:BENWARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13395 N MARANA MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-7008
Mailing Address - Country:US
Mailing Address - Phone:480-276-4620
Mailing Address - Fax:
Practice Address - Street 1:12100 N MOUNTAIN CENTRE RD APT 6201
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-5015
Practice Address - Country:US
Practice Address - Phone:520-682-4111
Practice Address - Fax:520-818-3630
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional